Discussion
Echocardiography has evolved rapidly
since its advent in the 1950s and is now the modality of choice for
imaging occupying cardiac lesions. It provides high-quality, real-time
images, which are invaluable in the evaluation of cardiac masses.
Although transthoracic echocardiography is an excellent initial
diagnostic technique for the evaluation and diagnosis of cardiac masses,
transesophageal echocardiography provides superior image resolution and
better visualization of cardiac masses in patients with poorly studied
transthoracic
echocardiography2.
For some diseases with quite similar
echocardiographic presentation need to differential diagnosis carefully,
especially for cases where the symptomatic presentation cannot be
clearly identified3.
The treatment options differ greatly
between the two groups of potentially confusing diseases, such as the
primary valve tumors and valve degeneration in this case.
Primary cardiac tumors are fairly uncommon, with an average incidence
rate about 0.02%, while primary valvular tumors account for only 10%
among them. Among the more common types are myxoma, papillary
fibroelastoma, and
lipoma4,5.
The features of echocardiogram are often pedunculate, often a solitary
mass, usually at the mid-portion of valve leaflets, and with a
frond-like characteristic
surface6. The primary
valvular tumors need to be
surgically removed if there is
mobility, even for asymptomatic patients, because of the potential
cerebral and cardiac
embolization7,8.Valvular
degenerative disease due to the absence of fibrin in the valve leads to
lengthy chordae tendineae and leaflet prolapse, which often causes
different degrees of valvular
regurgitation9,10.
In this case, the apex systolic
murmur was consistent with the degree of echocardiographic mitral valve
regurgitation.
Generally, only patients with severe mitral regurgitation combined with
symptoms of cardiac insufficiency require surgery. This patient had
severe mitral regurgitation before operation, and the wrong judgment
before operation did not cause any adverse effect.
However, for suspected valve masses
without valve regurgitation, more accurate evaluation and identification
of primary valvular tumors and valve degenerative lesions is clearly
warranted. For individual patient,
it may need to combine clinical symptoms and wide use of
echocardiography and CT or MRI to make the optimal clinical decision.