Rapidly growing papillary fibroelastoma complicated by myxoma
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CASE REPORT
Rapidly growing papillary fibroelastoma complicated by myxoma Seimei Go 1
&
Tomokuni Furukawa 1 & Kazunori Yamada 1 & Shinya Takahashi 2
Received: 28 June 2020 / Revised: 27 July 2020 / Accepted: 10 August 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract Rapidly growing papillary fibroelastoma complicated by myxoma is extremely rare. An 80-year-old male was transported to our hospital because of cerebral hemorrhage. Echocardiogram revealed a massive pedunculated tumor in the septum of the left atrium. The tumor extended to the mitral valve orifice and posed a risk of strangulation, yet removing it immediately would have required cardiopulmonary bypass with anticoagulant, which would have posed a serious risk of rebleeding. Magnetic resonance imaging showed that the tumor stalk was sufficiently thick for us to perform a standby surgery 1 month after cerebral hemorrhage. Follow-up echocardiogram prior to this surgery revealed a new, high-mobility tumor in the right ventricular septum. We resected these two tumors together. Histopathological examination showed that the tumor of the left atrium was a myxoma and the tumor of the right ventricle was a papillary fibroelastoma. The patient had a good postoperative course and was discharged without complications. Keywords Cardiac tumor . Papillary fibroelastoma . Myxoma . Double tumor
Introduction Primary cardiac tumors are rare diseases. Myxoma is the most common type of cardiac tumor, while papillary fibroelastoma (PFE) is the second most common. There are several case reports of double tumors of the heart in the literature [1, 2]. However, a rapidly growing papillary fibroelastoma complicated by myxoma is extremely rare. We report a case in which a papillary fibroelastoma appeared in the right ventricle during the waiting period before an operation to remove an accidentally discovered left atrial myxoma.
Case report The patient is an 80-year-old male. He was transported to our hospital for emergency treatment of cerebral * Seimei Go [email protected] 1
Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Nakashimacho 3-30, Nakaku Hiroshima-city, Hiroshima, Japan
2
Department of Cardiovascular Surgery, Hiroshima University, Hiroshima, Japan
hemorrhage and was given conservative treatment. During hospitalization, a transthoracic echocardiogram (TTE) for systemic evaluation was performed. A massive pedunculated tumor (40.4 × 23.5 mm) was found in the septum of the left atrium (Fig. 1a). Transesophageal echocardiography (TEE) revealed that the tumor extended to the mitral valve orifice and posed a risk of strangulation. A cardiac computed tomography (CT) scan was performed to evaluate coronary arteries and the tumor. No significant stenosis was found in the coronary arteries. The tumor had a stalk slightly below the oval fossa. To remove it immediately, however, we would have had to use cardiopulmonary bypass with anticoagulant, which would have posed a serious risk of rebleeding from his brain. M
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