• Images in cardiology

A 38 year old man presented with orthopnoea, palpitation, and paroxysmal nocturnal dyspnoea. Clinical examination revealed features of pulmonary oedema and mixed mitral valve disease as evidenced by the presence of a mid diastolic and ejection systolic murmur in the mitral area. Transthoracic echocardiogram showed a 2.4 cm spherical, mobile mass within the left ventricular cavity distorting the mitral valve and obstructing its orifice, causing mixed mitral valve disease. At operation, after establishing cardiopulmonary bypass, the left ventricular tumour was approached through the left atrium via a paraseptal approach. A 2.4 cm encapsulated, spherical tumour attached to the anterior papillary muscle by a broad pedicle was found obstructing the mitral valve orifice. It caused significant mitral stenosis and distorted the alignment of the mitral valve leaflets, preventing leaflet apposition and consequential mitral regurgitation (below left). The pedunculated tumour was mobilised into the left atrium and the pedicle divided from its attachment (below right). Repeat echocardiography showed a normal functioning mitral valve apparatus. Histological analysis revealed that this tumour was an endocardial haemangioma. Immunohistochemistry for factor 8 and CD34 were positive, confirming the haemangiomatous component in the tissue.

This is an interesting case of left ventricular haemangioma mimicking mixed mitral valve disease.