A 75-year-old male with DMII, hypertension, tobacco abuse and CAD s/p PCI who was referred with further cardiac evaluation post TIA symptoms. His transthoracic echo was abnormal and so we proceeded with TEE (images attached).
Please let me know what do you you think?
Interesting case.!
My assessment on these 2 TEE/TOE views (short axis mid-gastric & 5 chamber transesophageal view) shows preserved LV systolic function, LVEF 65%, mild LA enlargement, RA not well visualized, RV normal size and function with normal motion of TV, calcific AV noted. The MV leaflets have normal motion. However, there is large size (~ 1 cm) mobile globular echo density attached to the ventricular surface of the anterior mitral valve leaflet. I won't comment if it is calcified our note because the echo is over gained. Fibroelastoma would be on the top of my differential, thrombus and vegetation are less likely.
Let's see what other colleagues think!
Thank you for sharing.!
Thank you Aiman for your input. It appears to be over gained as I did take those short videos using my cellphone.
Would you recommend surgical removal?
Iād especially, the patient presented with possible cardio-embolic event, TIA.! TY
Myxoma /or fibroelastoma ready to exit the heart via the aortic valve
@Khaled Sleik your comment "ready to exit" made me wonder if we really know the exact mechanism of stroke in this scenario. Is it tumor migration, or the tumor becomes a nidus for a lot? I don't know the answer.
I am curious if someone can educate us on this. As in some examples, we see this "fibroelastoma" in a debilitated patient who is not a surgical candidate, then the question comes: any rule of antithrombotics?
Gelatinous fragments of myxoma and the detached filaments of the fibroelastoma is the likely cause of stroke