Title: Pedunculated Cardiac Mass (Fibroelastoma) in right Atrium and Anterior Mitral Valve Leaflet Prolapse in a Patient with Diabetic Ketoacidosis Diagnosed as DENOVO Type 1 Diabetes Mellitus: Case Report

Authors: Dr Rajendra Prasad, Dr Snigda Panuganti, Dr Balu Banoth, Dr Alla Krishnakar Reddy

 DOI: https://dx.doi.org/10.18535/jmscr/v9i6.25

Abstract

Few studies report an increased incidence of mitral valve prolapse in patients with type 1 DM, and a benign primary cardiac tumor like Papillary fibroelastoma, has potentially life-threatening complications. We report a patient with an initial diagnosis of diabetic ketoacidosis, his Echocardiography showed a pedunculated mass attached to the roof of right atrium with anterior mitral leaflet prolapse, mild MR,  mild LV dysfunction and minimal pericardial effusion . This  patient was treated for DKA ,sugars corrected and advised treatment with insulin and advised regular follow up to monitor and prevent complications

Keywords: Papillary fibroelastoma, Diabetic ketoacidosis, mitral valve prolapsed.

References

  1. Freed LA, Levy D, Levine RA, et al. Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med1999;341:1–7.
  2. Pu M, Gao Z, Zhang X, et al. Impact of mitral regurgitation on left ventricular anatomic and molecular remodeling and systolic function: implication for outcome. Am J Physiol Heart Circ Physiol2009;296:H1727–32
  3. Beeri R, Yosefy C, Guerrero JL, et al. Mitral regurgitation augments post-myocardial infarction remodeling failure of hypertrophic compensation. J Am Coll Cardiol2008;51:476–86.
  4. David SH Bel, Ronald T Acton. Diabetes Care Jun 1996, 19 (6) 672; Increased Prevalence of Mitral Valve Prolapse in IDDM .DOI:2337/diacare.19.6.672
  5. Reynen K. Frequency of primary tumors of the heart. Am J Cardiol 1996; 77: 107
  6. Straus R, Merliss R. Primary tumor of the heart. Arch Pathol 1945: 39:74.
  7. Levine RA, Jerosch-Herold M, Hajjar RJ. Mitral Valve Prolapse: A Disease of Valve and Ventricle. J Am Coll Cardiol. 2018;72(8):835-837. doi:10.1016/j.jacc.2018.07.006
  8. C. Hsu, S. Y. Tsao, S. M. Hou, S. W. Hsieh, and Y. C. Yeo . Papillary Fibroelastoma and Diabetic Ketoacidosis DOI:10.6314/JIMT.2017.28(1).07
  9. Kitabchi AE, Umpierrez GE, Murphy MB, et al. Management of hyperglycemic crises in patients with diabetes mellitus. Diabetes Care 2001; 24: 131-53.
  10. Liu CC, Chen KR, Chen HF, et al. Trends in hospitalization for diabetic ketoacidosis in diabetic patients in Taiwan: analysis of national claims data 1997-2005. J Formos Med Assoc 2010; 109: 725-34.
  11. .Tamin SS, Maleszewski JJ, Scott CG, et al. Prognostic and bioepidemiologic implications of papillary fibroelastomas. J Am Coll Cardiol 2015; 65: 2420-9.
  12. Gowda RM, Khan IA, Nair CK, et al. Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases. Am Heart J 2003; 146: 404-10.

Corresponding Author

Dr Snigda Panuganti

Department of General Medicine

SVS medical college and hospital, Mahabubnagar, Telangana, India