Aortic Valve Myxoma: A Tiny Cardiac Mass With Major Neurologic Consequences.

BACKGROUND

Aortic valve myxomas are exceptionally rare benign cardiac tumors with substantial embolic potential. Their imaging appearance may overlap with more common valvular tumors, creating diagnostic uncertainty.

CASE SUMMARY: A 42-year-old woman presented with aphasia and right arm weakness from recurrent embolic cerebral infarctions. Evaluation excluded hypercoagulable disorders, venous thromboembolism, and intracardiac shunting. Echocardiography identified a small mass on the right coronary cusp of the aortic valve, initially suspected to be papillary fibroelastoma. Surgical excision with valve repair was performed. Histopathology demonstrated characteristic neoplastic lepidic cells within a myxoid stroma, confirming aortic valve myxoma.

DISCUSSION: Fewer than 20 cases have been reported. This case highlights the embolic risk of small valvular tumors and the limitations of imaging in distinguishing myxoma from papillary fibroelastoma, underscoring the importance of histopathologic confirmation.

TAKE-HOME MESSAGES: Rare valvular tumors should be considered in unexplained embolic stroke. Definitive diagnosis requires pathology, guiding prognosis, and surveillance.