We experienced 2 cases of accessory mitral valve tissue (AMVT). Case 1 : A 56-year-old man was admitted with aortic regurgitation. Transthoracic and transesophageal echocardiography revealed AMVT with no left ventricular outflow tract obstruction. The patient underwent a successful aortic valvuloplasty. AMVT was carefully excised, because we suspected AMVT might be the cause of recurrent aortic regurgitation and left ventricular outflow tract obstruction with aging. Case 2 : A 63-year-old woman was admitted with mitral regurgitation due to infective endocarditis. During medical treatment, transthoracic and transesophageal echocardiography revealed membranous structure in the left atrium uneffected by antibiotics. Mitral valvuloplasty and resection of membranous structure was performed. The membranous structure was not vegetation and had no relationship to mitral regurgitation. Pathological examination proved AMVT. To our knowledge, this is the first report of AMVT in left atrium in an adult.

Cardiac papillary fibroelastoma (CPFE) is a rare tumor, and is usually located in the atrioventricular or ventriculoarterial valves. It is occasionally identified by echocardiography or surgery. It can also be an unexpected finding at autopsy. As this tumor often occurs in left-sided cardiac chambers, early aggressive surgical resection is required in order to prevent severe systemic embolic complications. However, the operative indications of tumors on the right cardiac chamber are controversial. The patient was a 73 year-old man. He had had cerebral infarction at age 58. Before the currently reported operation, we found CPFE on the tricuspid valve but we could not find a patent foramen ovale (PFO) by the usual examinations. During surgery, we found a CPFE on the tricuspid valve that had a short stalk and PFO. We cut the short stalk of the CPFE easily, and closed the PFO directly. This patient did not need complicated valve repair. We speculated that this cerebral infarction was caused by a CPFE on the tricuspid valve and patent foramen ovale. Echocardiography is very useful in diagnosing CPFE. However, we should not neglect the possibility of PFO before surgery. The postoperative course was uneventful. We concluded that early surgical resection of CPFE, even in right-sided cardiac chambers, should be performed in order to prevent severe embolic complications, even without PFO diagnosis.