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.