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Isolated myxoid degeneration of aortic valve: diagnostic dilemma
  1. Htay Htay Kyi1,
  2. Kewan Hamid1,2,
  3. Luay Alkotob1 and
  4. Thair Dawood1
  1. 1 Department of Internal Medicine, Hurley Medical Center/ Michigan State University, Flint, MI, USA
  2. 2 Combined Internal Medicine- Pediatric, Hurley Medical Center/Michigan State University, Flint, MI, USA
  1. Correspondence to Dr. Thair Dawood, tdawood1{at}


Myxoid degeneration of the aortic valve as a cause of acute aortic valve regurgitation in young age is uncommon. We report a 39-year-old African-American man with a history of epilepsy and hypertension who presented with a 1-month history of worsening shortness of breath. He was diagnosed with acute pulmonary oedema. Transoesophageal echocardiogram showed normal ejection fraction but severe aortic valve insufficiency with small masses on the ventricular side of the right and non-coronary cusps, small vegetations cannot be ruled out but other valves were normal. Subsequent cultures were negative for endocarditis. Myocardial positron emission tomography (PET) scan was strongly suggestive of cardiac sarcoidosis. However, this diagnosis was ruled out as well when he underwent aortic valve replacement with bioprosthetic valve as he did not want to take long-term anticoagulation. Histological examination of the aortic valve showed myxoid degeneration. The patient was doing very well 1 year after the surgery.

  • valvar diseases
  • medical education

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  • Contributors HHK developed the presented idea and wrote the summary, background, case presentation, investigations, differential diagnosis, treatment, and outcome and follow-up, modified the discussion part and contributed to the final manuscript. KH wrote the discussion part. LA gave opinion regarding cardiology standpoints, echocardiogram and myocardial PET. TD edited final manuscript. All authors provided critical feedback regarding the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer None

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.