Partial replacement of the left ventricular wall for a large intramural fibroma

Abstract

A case of successful operative treatment of an intramural fibroma of the left ventricular posterior wall is presented. Symptomatology, diagnosis, and a surgical procedure based on ventricular replacement using a doubled Dacron patch, fixed in "sandwich" technique, are discussed. It is possible to resect and replace large parts of the ventricular wall because of the well-developed compensatory capacity of the remaining unaffected myocardium in children.

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.…”