As vegetations typically

occur on the low pressure side of a high velocity turbulence jet, vegetations are often found on the atrial aspect of the mitral valve.16) However, there are no echocardiographic features that can absolutely differentiate myxomas from vegetations. Therefore, clinical settings must be considered when diagnosing the patient. The treatment of choice for myxoma is surgical removal, and complete excision is the goal. Inhibitors,research,lifescience,medical Immediate postoperative mortality ranges from 0% to 3.6%.17),18) Arrhythmia is a common postoperative complication, which may require long-term medication.18) Recurrence develops in 3% of the patients, and the rate is higher in familial cardiac myxomas.19) It is not known whether replacement of mitral valve reduces the recurrence of mitral valve myxoma.
A 14-year-old boy was admitted to our hospital due to sudden onset dyspnea. The patient had no past medical history and family history of lung disease and cardiac disease. Two weeks before admission, he suffered from non-productive cough.

At the time, Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical physical findings included a regular heart rate of 98 beats/minutes, a blood pressure of 120/80 mm Hg, respiratory rate of 28/minutes Hydroxychloroquine ic50 represented tachypnea, a body temperature of 36.4℃, resting oxygen saturation of 96%. He had a palpable four finger sized hepatomegaly, pre-tibial pitting edema. Thoracic auscultation revealed mid-diastolic murmur (Grade II) and inspiratory crackle was audible in both

lower lung fields. An electrocardiogram revealed a normal sinus rhythm with right axis deviation, right atrial enlargement. A chest X-ray showed mild cardiomegaly and mild pulmonary congestion (Fig. 1). On laboratory findings, Aspartate Aminotransferase/Alanine Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical Aminotransferase 136/106 IU/L, total bilirubin 1.0 mg/dL, pro-brain nitrouretic peptide 6,291 pg/mL. Transthoracic echocardiography to find cause of murmur showed a nodular, mobile, hyperechoic, 4.34 × 8.11 cm sized left atrial mass (Fig. 2) with moderate tricuspid regurgitation suggestive of pulmonary hypertension (maximal pressure gradient = 81.61 mm Hg, pulmonary artery systolic pressure = 101 mm Hg) (Fig. 4), and markedly enlarged right atrium and right ventricle. Left ventricular ejection fraction and regional wall motion were normal. We performed Oxygenase excisional biopsy for mass evaluation. The mass were grossly composed of several friable hemorrhagic nodular mass, measuring 6 × 5 × 4.5 cm in size (Fig. 6). On microscopic view, the mass were composed of setellate myxoma cells, inflammatory cells, much basophilic substance and slit like vessels that were compatible with myxoma. Fig. 1 Chest X-ray showed mild cardiomegaly and increased pulmonary vascular marking in both lungs. Fig. 2 A: Transthoracic echocardiography showed a 6 × 5 × 4.5 cm sized large left atrial mass (arrow) and right ventricular enlargement in apical 4 chamber view.