Ann Thorac Surg 2002;73:1305-1306
© 2002 The Society of Thoracic Surgeons
Case report
Pulmonary valve lipoma presenting as syncope
Carlo Pederzolli, MD*a,
Alberto Terrini, MDa,
Alessandro Ricci, MDa,
Alessandro Motta, MDa,
Luigi Martinelli, MDb,
Angelo Graffigna, MDa
a Cardiac Surgery Unit, Ospedale Santa Chiara, Trento Italy
b Cardiac Surgery Unit, Ospedale San Martino, Genoa, Italy
Accepted for publication July 30, 2001.
* Address reprint requests to Dr Pederzolli, Cardiac Surgery Unit, Ospedale Santa Chiara, Largo Medaglie d’oro 9, 38100 Trento, Italy
e-mail: capede{at}tin.it
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Abstract
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We report a case of a pulmonary valve lipoma presenting as syncope in a 28-year-old woman. Surgical excision of the mass was performed in urgency and the patient was discharged uneventfully.
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Introduction
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Cardiac tumors are rare and almost always benign [1] and usually include myxoma, fibroma, papilloma, hemangioma, and, in children, rhabdomyoma. They arise from myocardium, endocardium, or epicardium. Involvement of heart valves is extremely rare. We report a case of a lipoma arising from the pulmonary valve in a female patient. To our knowledge, 5 lipomas on mitral valve and 3 on tricuspid valve have been previously reported [2]; 13 pulmonary valve papillary fibroelastomas were discovered (mostly incidentally at autopsy or during surgery) [3]; we report a lipoma on the pulmonary valve.
A 28-year-old female patient who was in good health previously, had a recent history of recurrent syncope. Cardiovascular examination revealed an intermittant systolic click on the precordium. Laboratory findings and electrocardiogram were normal. Transthoracic and transesophageal echocardiography (Fig 1)
revealed a pedicled mass arising from the pulmonary valve and occluding, from time to time, the pulmonary artery. She was referred to surgery and operated on in urgency.
After cardiopulmonary bypass and cardioplegic arrest, the main pulmonary artery was opened and a 2 x 2 x 1.7-cm pedicled mass arising from the left pulmonary leaflet was found and excised (Figs 2, 3).
The pedicle was excised and a 6-0 monofilament suture was placed to repair the leaflet. Other leaflets were normal and pulmonary valve was preserved.
The postoperative course was normal and the patient was discharged 6 days after surgery. At a 2-year follow-up, the patient remains asymptomatic and control echocardiogram demonstrates correct function of pulmonary valve.
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Comment
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Cardiac lipomas are most often asymptomatic, and usually symptoms depend upon tumor size and location [4]. Large subpericardial lipomas exerting pressure on cardiac structures may determine angina or interfere with pump function; intramyocardial lipomas can produce damage to normal electric conduction and arrhythmias. Since lipoma is usually intramural or epicardial in location, it rarely obstructs blood flow [5]. Lipomas of cardiac valves are extremely rare. They can cause either valve regurgitation or mechanical flow obstruction. Syncope can be the first dramatic symptom of these lesions. Echocardiography can demonstrate the presence of a mass, without defining its nature [6]. In elective conditions, however, prediction of nature can be done with aid of computed tomography and magnetic resonance [7]. Due to the benign nature of these lesions, mass excision can be as limited as possible, thus preserving native structures. The prognosis after surgical treatment is excellent.
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References
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Caralps J.M., Martì V., Ferrés P., et al. Mitral valve repair after excision of a fibrolipoma. Ann Thorac Surg 1998;66:1808-1809.[Abstract/Free Full Text]
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Crotty T.B., Edwards W.D., Oh J.K., Rodeheffer R.J. Lipomatous hamartoma of the tricuspid valve: echocardiographic-pathologic correlations. Clin Cardiol 1991;14:262-266.[Medline]
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Bhagwandien N.S., Shah N., Costello J.M., Jr, Gilbert C.L., Blankenship J.C. Echocardiographic detection of pulmonary valve papillary fibroelastoma. J Cardiovasc Surg 1998;39:351-354.[Medline]
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Grande A.M., Minzioni G., Pederzolli C., et al. Cardiac lipomas. Description of 3 cases. J Cardiovasc Surg 1998;39:813-815.[Medline]
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Alam M., Silvermann N. Apical left ventricular lipoma presenting as syncope. Am Heart J 1993;125:1788-1790.[Medline]
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Borges A.C., Witt C., Bartel T., et al. Preoperative two- and three-dimensional transesophageal echocardiographic assessment of heart tumors. Ann Thorac Surg 1996;61:1163-1167.[Abstract/Free Full Text]
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Kamya H., Ohno M., Iwata H., et al. Cardiac lipoma in the interventricular septum: evaluation by computed tomography and magnetic resonance imaging. Am Heart J 1990;119:1215-1217.[Medline]
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Abstract
Introduction
