Intramural fibroma of the left ventricle

Abstract

A case of left ventricular fibroma in a symptomless 17-year-old girl is described. The tumour was extensive and after its removal inadequate left ventricular function resulted in death at operation. The role of surgical treatment is discussed.Primary tumours of the heart are rare (Prichard, 1951;Hudson, 1965;Heath, 1968) and particularly uncommon is the intramural ventricular fibroma; only 36 cases had been reported up to 1967 (Geha, Weidman, Soule, and McGoon, 1967). Most of these intramural fibromas were found in infants and young children at either necropsy or thoracotomy, but over the past 15 years the diagnosis has been made before operation and in a few patients successful surgical removal has been accomplished (Parks, Adams, and Longmire, 1962;Geha et al., 1967;Bjork, Dahlgren, Rudhe, Zetterqvist, 1967;Kay et al., 1968;Osano et al., 1969).Because of the rarity of these tumours Freeman, Geer, Randall, and Palfrey (1963) suggested that cases should be reported in order to increase knowledge of their natural history, diagnosis, and treatment. The case described here is that of a young girl with a large intramural fibroma of the left ventricle, diagnosed preoperatively, who died at operation. CASE REPORTThe patient, a 17-year-old girl, was referred to the Department of Cardiology, Royal Infirmary, Edinburgh, by her general practitioner who had detected a precordial systolic murmur at routine medical examination.She was asymptomatic and apart from common childhood illnesses her previous health had been excellent. On specific enquiry, however, she had noticed occasional 'missed beats' during the preceding few months.She was of average build with sinus arrhythmia and a systemic blood pressure of 115/60 mmHg. The jugular venous pulse was normal. There was no cardiomegaly and no thrill, but systolic pulsation was palpable at the upper left sternal edge. Heart sounds were normal with inspiratory splitting of the second heart sound and no accentuation of the pulmonary component. A short grade 2/6 mid-systolic murmur was heard in the pulmonary area but was not audible in the axillae or over the back. No ejection sound, diastolic murmur or other abnormal physical sign was detected.The electrocardiogram ( Fig. la and b) showed sinus arrhythmia with occasional ventricular extrasystoles and symmetrical inversion of the T waves in the high anterolateral leads. Her chest radiograph (Fig. 2) showed a localized bulge on the upper left heart border. Pulmonary arteries and pulmonary vascularity were normal. No calcification was detected at fluoroscopy. The full blood picture, blood urea, electrolytes, and plasma proteins were normal.At cardiac catheterization pressures and oxygen saturations on the right and left sides of the heart were normal. Cine-angiography, performed from the right and left ventricles, demonstrated a large mass encroaching on the outflow tract of both ventricles and displacing the interventricular septum to the right. The left atrium was also distorted and the left atrial appendage was not filled with c...

Sudden Death Due to Infiltration of Left Bundle Branches by Interventricular Septal Cardiac Fibroma

“…Cardiac magnetic resonance provides an unrestricted field of view in the characterization of cardiac masses, and multidetector computed tomography is especially useful for detecting calcification (7). Despite the fact, that high quality imaging is a common available method for the correct diagnosis, sudden death may occur without any previous symptoms as happened in our case (24,25).…”

Successful surgical management of ventricular fibromas in children

“…Several isolated case reports and small case series of complete or partial excision [8][9][10][11][12][13][14][15] have been published, and these have included techniques such as the Batista ventriculoplasty and Dacron patch sandwich for closure of the tumor bed after resection. The alternative management approaches to cardiac fibroma reported by others included functional single ventricle palliation, 16 single ventricle palliation as a bridge to transplantation, 17 partial excision with single ventricle palliation, 18 initial single ventricular palliation followed by resection, 19 staged resection, 20 and orthotopic heart transplantation as a primary surgical option for large fibromas, in particular, those involving the interventricular septum.…”

“…5,6 Although major strides have been made in establishing the diagnosis, especially with noninvasive imaging, 7 management strategies, in particular, surgical strategies, have not been well-defined. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] The goal of the present study was to review our institutional experience with surgical management of ventricular fibromas, with special attention to the surgical techniques used for successful resection and amelioration of the potentially life-threatening arrhythmias. We chose to focus on the outcomes of patients who had undergone surgical management of symptomatic ventricular fibroma, because reports have varied on the ideal management of these tumors and have included resection, transplantation, and single ventricle palliation.…”