Left ventricular myxoma: Hard to see, hard to hunt

This study presents the case of a 60-year-old woman with diplopia of embolic origin. On transthoracic echocardiography, she was diagnosed with a mobile pedunculated mass protruding in the left ventricular outflow tract (Fig. 1a). Parasternal long axis view revealed an intracardiac mass anchored in the postero-inferior interventricular septum close to the mitral tendinous cords without interference of aortic or mitral valve functionality (Fig. 1b). Cardiac tomography confirmed this diagnosis. The in tracardiac mass was located in the left ventricle, anchoring in the posterior part of the interventricular septum. The mass measured 20x9x10 mm (longitudinal, transverse and craniocaudal diameters, respectively) attached by an 8.7 mm pedicle (Fig. 1c and 1d). Cardiac surgery under cardiopulmonary by-pass was performed. Complete excision required a combined approach using aortotomy and transseptal left atriotomy. Initial transverse aortotomy revealed an inadequate access, given that it was difficult to achieve complete excision and safe the surgical resection margin because of the long distance from the aortic annulus to tumoral pedicle (4 cm) (Fig. 1e).