Ann Thorac Surg 2000;70:969-970
© 2000 The Society of Thoracic Surgeons
Case report
Right ventricle lipoma with pseudoaneurysmatic appearance
Omeros Artemiou, MDa,
Walter Klepetko, MDa,
Helmut Baumgartner, MDb,
Herbert Frank, MDb,
Michael Grimm, MDa,
Ernst Wolner, MDa
a Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria
b Department of Cardiology, University of Vienna, Vienna, Austria
Address reprint requests to Dr Artemiou, Department of Cardiothoracic Surgery, University of Vienna, Währinger Gürtel 18-20A-1190, Vienna, Austria
e-mail: omeros.artemiou{at}univie.ac.at
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Abstract
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The case of a 78-year-old female patient, with a large lipoma (13 x 17 x 10 cm) of the right ventricle, appearing pseudoaneurysmatic, is presented. Radical resection left a considerable right ventricle wall and interventricular septum defect which was reconstructed with a bovine pericardium patch.
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Introduction
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Cardiac lipomas are very uncommon findings and only a few of them cause symptoms, which develop depending on size and localization. More than 60 cases have been reported up to now. We report our recent experience of managing a patient with a large lipoma, communicating with the right ventricle.
A 78-year-old woman was referred to our clinic for treatment of a symptomatic intrapericardial tumor which was communicating with the right ventricle (RV). The tumor was an incidental finding 10 years before, when the patient underwent thymoma resection through left lateral thoracotomy in a peripheral hospital. Intraoperatively, the tumor imposed in association with the heart, and was accompanied by pericardial effusion. Since no cardiac-surgical facilities were available in that hospital, no resection was attempted. The effusion was drained through a wide pericardial fenestration. At that time, magnetic resonance imaging (MRI) revealed a large tumor with a cavitation and communication with the RV. Needle biopsy evidenced lipomatous tissue.
The patient refused to undergo surgery until recently. In the last 3 months, however, she sustained frequent episodes of left heart failure, that made her agree to an operation. On chest roentgenogram, the cardiac silhouette appeared enlarged reaching the left chest wall and the posterior mediastinum (Fig 1). MRI demonstrated a 13 x 17 x 10 cm intrapericardial tumor with a central cavitation (Fig 2). The cavitation consisted of a multichambered communicating system which was communicating with the RV. It was surrounded by a 5 cm thick coat, compatible with lipomatous tissue. The left lung was atelectatic. No growth of the outer diameter of the tumor was observed in comparison to the MRI finding 10 years ago. However, the cavitation appeared enlarged. Transesophageal-echocardiography demonstrated blood flow (maximum velocity = 2.9 m/s) between RV and cavitation. No thrombus could be detected. All valves appeared normal and no involvement of the tricuspid valve was observed.
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Fig 1. (A) Anteroposterior and (B) lateral view of the preoperative chest roentgenogram showing an enlarged cardiac silhouette.
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Fig 2. Transverse magnetic resonance image demonstrating the tumor (T) and the cavitation (C) communicating with the right ventricle (RV) causing a collapse of the left lung.
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Preoperative heart catheterization showed a displacement of both ventricles with normal systolic function but an increased left ventricle filling pressure (20 mm Hg). Right ventriculography demonstrated a blood flow between RV and cavitation. The pulmonary artery pressure (36/18/26 mm Hg) and right atrial pressure (14/11/10 mm Hg) were slightly increased. Cardiac output was 5.6 L/min and the coronaries appeared normal. The operation was performed through a median sternotomy on normothermic total cardiopulmonary bypass. The mass was arising from the apex of the right ventricle over a surface of 4 cm. It was easily mobilized from pericardium and was resected including a portion of the RV wall. The right anterolateral part of the interventricular septum appeared then infiltrated, too, and was subsequently resected as well. The tumor weighed 1,350 g (Fig 3). Reconstruction of the ventricle and septum was performed using a glutaraldehyde-treated bovine pericardial patch. The patch was sutured L-shaped covering both borders of the septum and ending at the free right ventricular wall. The postoperative course was uneventful and the patient was discharged home on day 14. Histopathological examination confirmed benign epicardial lipoma with an epicardium coated multichambered cavitation. The patient is, 1 year after operation, free of symptoms.
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Fig 3. A view of the tumor after resection. Note the orifice of the cavitation which was communicating with the right ventricle.
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Comment
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Cardiac lipomas are a rare finding and can originate from any anatomical site of the heart [1]. Even though small tumors are mostly asymptomatic incidential findings, larger tumors can cause cardiac dysfunction due to compression [2, 3], or interfere with cardiac conduction when they infiltrate the myocardium. In literature, they are mainly described as solid tumors [1, 4, 5]. Mullen and associates [6] described a case where a lipoma with cavitation communicating with the right atrium was treated by resection and reconstruction using autologous pericardium. In this case the lipoma was communicated with a ventricle which contributed to the progressive enlargement of the central cavitation. Potential complications of this form are compression of the surrounding organs, intracavitary thrombosis, and rupture of the lipomatous wall. The indication for operation should therefore be liberal in order to prevent such complications, considering the individual prognosis of each patient.
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References
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Hananouchi G.I., Golf W.B. Cardiac lipoma. Magn Reson Imaging 1990;8:825-828.[Medline]
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Moulton A.L., Jaretzki A., III, Bowman O.F., Silverstein E.F., Bregman D. Massive lipoma of the heart. NY State J Med 1976;76:1820-1825.[Medline]
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Harjiola P.-T., Ala-Julju K., Ketonen P. Epicardial lipoma. Scand J Thor Cardiovasc Surg 1985;19:181-183.[Medline]
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Lang-Lazdunski L., Oroudji M., Pansard Y., Vissuzaine C., Hvass U. Successful resection of giant intrapericardial lipoma. Ann Thorac Surg 1994;58:238-241.[Free Full Text]
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Eng J., Ruiz K., Kay P.H. Giant epicardial lipoma. Int J Cardiol 1992;37:115-117.[Medline]
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Mullen J.C., Shipper S.A., Sett S.S., Trusler G.A. Right atrial lipoma. Ann Thorac Surg 1995;59:1239-1241.[Abstract/Free Full Text]
Accepted for publication January 6, 2000.
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Abstract
Introduction
