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(Circulation. 1999;99:2342-2344.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Primary Cardiac Malignancy Masquerading as Mitral Valve Stenosis

Vijay D. Subbarao, MD; Richard G. Sheahan, MD; Vincent R. Conti, MD; Eduardo Eyzaquirre, MD; Masood Ahmad, MD

From the Divisions of Cardiology (V.D.S., R.G.S., M.A.) and Cardiothoracic Surgery (V.R.C.) and Department of Pathology (E.E.), University of Texas Medical Branch at Galveston.

A60-year-old white woman presented with a history of exertional shortness of breath rapidly progressing to orthopnea and episodes of paroxysmal nocturnal dyspnea over a period of 4 weeks. Her past medical history included hypertension; sick sinus syndrome, for which she had received a pacemaker; and a left carotid endarterectomy. Physical examination revealed normal vital signs, jugular venous distension of 5 cm, bibasilar rales, and a II/VI middiastolic murmur heard at the apex of the heart without an opening snap.

A transthoracic echocardiogram revealed a markedly thickened anterior leaflet of the mitral valve with limited diastolic excursion (Figure 1A). A possible mass hugging the atrial side of the anterior leaflet could not be excluded. The posterior leaflet had preserved motion. Doppler echocardiography across the mitral valve obtained a mean gradient of 20 mm Hg, with a peak gradient of 47 mm Hg and a calculated valve area of 1.57 cm² by the pressure half-time method (Figure 1B). The transesophageal echocardiogram delineated a mass involving the anterior leaflet of the mitral valve and extending to the interatrial septum, with consequent obstruction of the valve (Figure 1C and 1D). The left atrium was otherwise normal.

View larger version (70K): [in this window] [in a new window]   Figure 1. A, Parasternal long-axis view revealing thickened anterior leaflet of mitral valve (MV) and a normal left atrial (LA) size; B, pressure half-time (PHT) calculation showing mitral valve area of 1.57 cm2; C, transesophageal echocardiogram revealing mass on anterior leaflet of mitral valve; and D, turbulent flow across valve signifying severe obstruction. LV . . . [Full Text of this Article]

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