Ann Thorac Surg 2006;82:1512-1513
© 2006 The Society of Thoracic Surgeons
Case Reports
Giant Cardiac Fibroma
Takeki Ohashi, MD*,
Teiji Asakura, MD,
Nobuhiro Sakamoto, MD,
Hiroya Shimizu, MD,
Tuyoshi Yoshida, MD
Cardiovascular Surgery Department, Nagoya Tokushukai General Hospital, Kasugai-city, Aichi, Japan
Accepted for publication January 19, 2006.
* Address correspondence to Dr Ohashi, Cardiovascular Surgery Department, Nagoya Tokushukai General Hospital, 2-28-1, Kozoji-cho, Kasugai-city, Aichi, 487-0013 Japan (Email: o-takeki{at}nagoya.tokushukai.or.jp).
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Abstract
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A 29-year-old woman who presented with persistent ventricular premature beat during her delivery was referred to us. Her cardiac echocardiography showed a giant tumor located in the posterior wall of the left ventricle. She had no symptoms of heart failure. Partial resection of the mass was safely conducted using cardiopulmonary bypass. The histopathologic finding was fibroma. She has been doing well 6 years after operation. Periodic echocardiography has showed no growth in this tumor.
Cardiac fibromas are rare tumors [1, 2]. Cardiac fibroma treatment varies depending on tumor size and location influence on cardiac function and symptoms [1–4].
A 29-year-old woman was referred to our unit for persistent unifocal ventricular premature contraction during her delivery. The echocardiography showed giant solid 7 x 5 x 4 cm mass located mainly in the posterior and lateral left ventricle (Fig 1). There was no involvement of the mitral valve or left ventricle. Coronary angiogram showed normal coronary arteries with neither obstruction nor feeding arteries to the tumor. She had no history of cardiac events such as heart failure or syncope before her delivery. After delivery her ventricular premature contraction ceased. In December 1999, an operation was performed using cardiopulmonary bypass with cardioplegic arrest. The tumor was a white-colored, elastic, hard mass located in the posterior wall of the left ventricle (Fig 2). There was no pericardial effusion or bleeding. Instead of complete removal of the tumor, we chose to make a partial excision of a 5-mm cube mass for confirmation of diagnosis. A histologic finding showed cardiac fibroma.
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Fig 1. (A) Preoperative echocardiography showing giant tumor located in the lateral and the posterior wall of the left ventricle. No pericardial effusion was seen. (B) Computed tomographic scan showed huge tumor appended into the posterior left ventricle.
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Fig 2. Operative finding showed white elastic solid mass attached and infiltrated into the posterior and the lateral wall of the left ventricle. The apex of the heart was lifted upward and the tumor was exposed using cardiopulmonary bypass with cardioplegic arrest.
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The postoperative course was uneventful. She has been doing well for 6 years without any cardiac symptoms. The postoperative periodic echocardiography showed no tumor growth.
Indications for operation are controversial and little is known about early and late results of operation for cardiac fibroma. In some cases, complete resection with reconstruction is preferable. Heart transplantation was reported to be done in some cases due to giant occupying tumor in the heart [3]. However, in other instances, partial excision resulted in good morbidity and long-term survival [1, 2].
In this case, radical complete resection may have been considered. However, removal of a huge tumor in the left ventricle was believed to be too invasive because she was asymptomatic, and because cardiac function was not influenced. In addition, if the tumor was malignant, chemotherapy rather than radical resection would be recommended. So we made the choice to make a small excision for confirmation of histologic findings of the tumor. She is now doing very well without any symptoms or any required drugs. We believe that the cardiac fibroma seems benign, with little growing in spite of the huge size, and that after histologic confirmation, careful observation is enough except in the presence of risk of heart failure or sudden death.
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References
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- Cho JM, Danielson GK, Puga FJ, et al. Surgical resection of ventricular cardiac fibromas: early and late results Ann Thorac Surg 2003;76:1929-1934.[Abstract/Free Full Text]
- Burke AP, Rosado-de-Christenson M, Templeton PA, Virmani R. Cardiac fibroma: clinicopathologic correlates and surgical treatment J Thorac Cardiovasc Surg 1994;108:862-870.[Abstract/Free Full Text]
- Valente M, Cocco P, Thiene G, et al. Cardiac fibroma and heart transplantation J Thorac Cardiovasc Surg 1993;106:1208-1212.[Abstract]
- Williams DB, Danielson GK, McGoon DC, Feldt RH, Edwards WD. Cardiac fibroma: long-term survival after excision J Thorac Cardiovasc Surg 1982;84:230-236.[Abstract]
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