A report of a surgical case of papillary fibroelastoma in the left ventricular outflow tract.

While a 74-year-old man with a past history of cerebral infarction was undergoing surface echocardiography due to transient atrial fibrillation, an unstable, pedunculated tumor was detected in the left ventricular outflow tract. As the results of transesophageal echocardiography suggested a left ventricular tumor, semi-emergency surgery was performed. Based on pathological findings, the tumor was diagnosed as papillary fibroelastoma. This tumor mainly affects the cardiac valves and is often discovered during open-heart surgery or autopsy. This report presents a very rare case of preoperatively identified papillary fibroelastoma in the left ventricular outflow tract.     

Intraoperative trans-mitral endoscopic resection of left ventricular tumor

A successful resection of left ventricular tumor in an 82-year-old woman who had undergone coronary artery bypass grafting ten years ago is presented. In an attempt to make a procedure less invasive, we chose a trans-mitral endoscopic resection with minimum dissection because of reoperation on patient of advanced age. With the use of cardiopulmonary bypass and cardioplegic protection, the right side of left atrium was incised longitudinally. The endoscope was inserted in the ventricle via the mitral valve. A stalk of the tumor was cut by snare strangulation and the whole tumor was extracted endoscopically. The postoperative course was uneventful. To our best knowledge, this is the first report on endoscopic resection of the left ventricular tumor via a mitral valve. This method appear to be the choice in resecting the left ventricular tumor.     

Transesophageal echocardiographic diagnosis of multicentric left ventricular myxomas mimicking a left atrial tumor.

We report a case of multicentric left ventricular myxomas with prolapse of one myxoma into the left atrium during ventricular systole that mimicked a left atrial tumor. The transthoracic echocardiogram showed large masses in the region of the mitral valve leaflets consistent with vegetations or tumors. A computed tomographic scan of the chest demonstrated two distinct left atrial masses, one of which appeared to prolapse from the left atrium into the left ventricle. Intraoperative transesophageal echocardiography showed a large pedunculated mass moving between the two left-sided cardiac chambers with intermittent trapping of the mass in the left atrium. The mass was attached to the left ventricular posteromedial papillary muscle by a long stalk. Another adjacent large ventricular mass was also noted in the left ventricle. These findings were confirmed at operation, which also demonstrated a third small tumor arising from the atrial aspect of the posterior mitral leaflet.     

Mobilization of the posterior leaflet of the mitral valve for resection of a left ventricular tumor producing carbohydrate antigen 19-9

We report an extremely rare case of a left ventricular tumor producing carbohydrate antigen 19-9 (CA19-9). A 43-year-old man with an episode of right hemiplegia underwent an emergent operation for a left ventricular tumor just beneath the posterior leaflet of the mitral valve. The tumor was successfully resected by mobilization of the posterior leaflet of the mitral valve. The resected specimen was immunoreactive for CA19-9.     

Left ventricular diverticulum with hypertrophy of the left ventricular apex.

A surgical case of diverticulum in the left ventricular apex is presented. A two-dimensional echocardiogram and magnetic resonance image showed a calcified tumor buried in the marked hypertrophied apex of the left ventricle. Enucleation of the oval and hard tumor (4 x 2.5 x 2.5 cm) was performed through the apex, and the defect was anastomosed by buttress sutures. Histologic examination demonstrated that the tumor cavity was filled with a thrombus encapsulated by thickened and calcified endocardium that extended to the left ventricular cavity. In this report, the etiology of the diverticulum with a hypertrophied myocardium is discussed.     

Pedunculated left ventricular rhabdomyoma

A patient with an unusual left ventricular outflow tract obstruction caused by a solitary pedunculated left ventricular rhabdomyoma is described. Diagnosis was based on two-dimensional echocardiographic findings alone. The obstructive portion of the tumor was successfully removed from the interventricular septum by an aortic root approach.     

Intraoperative Endoscopic Resection of Left Ventricular Tumors

Two cases involving patients who underwent a successful endoscopic resection of a left ventricular tumor are presented herein. One was an 82-year-old woman with a left ventricular papillary fibroelastoma, who underwent previous coronary artery bypass grafting. In an attempt to make the procedure less invasive, we used an endoscope. With a full sternotomy, cardiopulmonary bypass, and cardioplegic protection, the endoscope was inserted into the left ventricular cavity through the mitral valve. The other patient was a 63-year-old man with left ventricular papillary fibroelastoma, in whom we performed an endoscopic transaortic resection. The endoscope provided an excellent view, and the tumors were easily extracted in both cases without any complications.     

Mobilization of the anterior mitral leaflet for excision of a left ventricular myxoma.

Left ventricular myxomas are extremely rare. We report use of a left atrial approach with mobilization of the anterior mitral valve leaflet to enhance exposure of the subvalvar region and facilitate excision of a left ventricular myxoma entangled within the chordal apparatus, lying between the anterolateral papillary muscle and the left ventricular wall. The detached mitral leaflet was reattached to the annulus with a continuous suture. The tumor was completely excised, thus avoiding a separate transventricular or transaortic approach.     

Surgical removal of a left ventricular thrombus associated with cardiac sarcoidosis

We report successful surgical management of a 31-year-old man with a left ventricular thrombus following heart failure due to cardiac sarcoidosis. Preoperative echocardiography showed diffuse hypokinesis and a mobile ball-like thrombus in the left ventricle. Computed tomography revealed a left ventricular tumor and bilateral hilar lymphadenopathy, while MRI of the brain showed small infarctions in the occipital lobe. Postoperative pathologic examination of a specimen from the left ventricular free wall and a mediastinal lymph node revealed non-caseating granulomas consistent with cardiac sarcoidosis. The patient was referred to a cardiologist for further treatment with prednisolone. This is a rare case of surgical removal of a left ventricular ball-like thrombus in a patient with cardiac sarcoidosis.     

Reconstruction of the left ventricle in a patient with cardiac hemangioma at the apex

Cardiac hemangiomas in the left ventricle are extremely rare. A 34-year-old woman, without symptoms, with a diagnosis of cardiac tumor at the apex of the left ventricle was referred to us. The tumor was surgically resected, and the diagnosis was hemangioma. The Jatene technique, originally introduced for left ventricular aneurysmectomy was excellent for repair after resection of a cardiac tumor at the apex.     

Thoracoscopic removal of a papillary fibroelastoma in the left ventricular apex

Primary cardiac tumors located deep in the left ventricle present a surgical challenge. A mobile tumor located in the left ventricular apex was incidentally discovered on echocardiography in an 81-year-old female. The tumor was removed using a combined sternotomy and chest-port approach assisted by thoracoscopy. The use of an endoscopic sucker, instead of an endoscopic grasper, to retract the tumor helped keep the removal of the tumor en bloc uncomplicated. Detailed preoperative information about tumor location, size, and attachment to the endocardium facilitated the planning of the surgical approach and the instrumentation needed, which led to the successful removal of the deeply located left ventricular tumor. The surgical approach and instrumentation of previous case reports are reviewed.     

Malignant Peripheral Nerve Sheath Tumor Arising from the Left Ventricle

Abstract We report a case of a 32-year-old female who underwent complete excision of a malignant left ventricular peripheral nerve sheath tumor. Malignant peripheral nerve sheath tumors in the mediastinum, including the pericardium, are rare. This case report describes a malignant peripheral nerve sheath tumor arising from the left ventricular origin for which complete excision was possible. (J Card Surg 2012;27:567-570).     

A surgical case of left ventricular pseudoaneurysm complicating myocardial infarction in a diabetic patient on dialysis.

A 57-year-old man was hospitalized with dyspnea and heart failure. We performed an electrocardiogram, coronary angiogram, echocardiogram, and magnetic resonance imaging. He was diagnosed with a left ventricular pseudoaneurysm (i.e., heart tumor) at the posterolateral wall. Minimal contrast medium was utilized when making the diagnosis as the patient was on dialysis. We subsequently repaired the ventricular unruptured pseudoaneurysm and performed a coronary artery bypass grafting. This case presented difficulty in ascertaining the difference between a cardiac tumor and a ventricular pseudoaneurysm.     

A case report of successful surgical removal of a lipoma in the left ventricle

A 63-year-old man with anterior chest oppression was diagnosed as an acute myocardial infarction. The two-dimensional echocardiogram revealed a mass which bulged into the left ventricular cavity. Subsequently, the computed tomographic findings of the mass lesion demonstrated the attenuation values of -49 Hounsfield units, which corresponded to that of fatty tissues. From these findings the left ventricular lipoma was highly suspected. The tumor existed at the base of the anterior papillary muscle. It was successfully resected and mitral valve replacement was performed concomitantly. The tumor was yellowish and sized by 25 X 20 mm. On histological examination of the specimen, the tumor was composed of mature fatty cells. CT scanning was very useful for the preoperative evaluation of lipoma.     

原发性左心室肿瘤的病理特点分析

目的总结原发性左心室肿瘤病理特点及其对外科治疗的影响。方法回顾性分析中国医学科学院阜外医院2008年1月至2019年3月32例原发性左心室肿瘤患者的临床资料,其中男17例、女15例,平均年龄(33.88±17.89)岁。分析不同的左心室肿瘤病理类型对手术结果的影响。结果32例左心室原发性肿瘤患者接受外科手术,术后病理检查提示良性肿瘤31例,其中粘液瘤10例、脂肪瘤7例、纤维瘤4例、血管瘤3例、横纹肌瘤2例、囊肿2例、神经鞘瘤1例、乳头状纤维弹力瘤1例、瓣叶淋巴管海绵状瘤样增生1例;左心室低恶性肿瘤为类癌1例。30例患者在全身麻醉、低温、体外循环心肌冷停跳液灌注下进行手术;2例患者行常温手术,全身麻醉下未使用体外循环。9例患者左室肿瘤部分切除,其中6例左室脂肪瘤、2例左室横纹肌瘤、1例神经鞘瘤;23例患者左室肿瘤完整切除。患者无住院死亡,均未发生出血、二次开胸、低心排血量综合征、栓塞等并发症。患者术后复查正常,均顺利出院,住院时间为(8.1±2.7)d。术后6个月内,32例患者返院复查超声全部正常。随后,32例患者通过电话或门诊随访,失访3例,随访率为90.63%。随访时间为3~120(61.4±38.5)个月,部分切除的2例患者复发:神经鞘瘤1例,30个月后复发;二次左心室腔内脂肪瘤1例,15个月后肿瘤增大,导致二尖瓣大量反流。结论手术切除是目前治疗左心室良性肿瘤的首选方法,对于恶性左心室肿瘤则要慎重,需要仔细评判手术风险。大多数左心室原发性肿瘤需要尽早手术,术者要根据不同的肿瘤病理类型,制定不同的手术策略。     

Peculiar computed tomographic images after intracranial use of microfibrillar collagen hemostat: report of three cases

After the intracranial application of microfibrillar collagen hemostat (Avitene), CT revealed contrast enhancement suggestive of brain abscess or residual or recurrent tumor in three patients. The first case was a 22-year-old male with left ventricular oligodendroglioma. At operation Avitene was applied to the ventricular wall and incised frontal lobe. Two months after the operation CT revealed ring enhancement at the left frontal lobe and ventricular enlargement. Craniotomy was performed again. Histological examination, however, revealed no recurrent tumor but residual Avitene and granulation. The second case was a 57-year-old female with left parietal glioblastoma multiforme. At operation Avitene was applied to the tumor cavity. Two months after the operation CT showed ring enhancement and craniotomy was performed again. Histological examination revealed residual Avitene and necrotic tissue. Five months after the first operation, craniotomy was performed for the third time, because recurrence was suspected after a CT scan. Histological examination revealed recurrent tumor and residual Avitene. The third case was a 19-year-old male with left frontal astrocytoma. Two months after the operation when Avitene was used for hemostasis, marked ring enhancement was observed. Five months after the operation, however, enhancement in CT was weak. The CT findings in these patients were characterized by the abnormally long duration of enhancement (five months) and by enhancement more marked two to three months after the operation than immediately after it. Based on these findings brain abscess or residual or recurrent tumor rather than normal healing was more suspect as the cause of this phenomenon. Brain abscess was ruled out, because the peripheral leukocyte count, erythrocyte sedimentation rate, CRP, etc. were normal.(ABSTRACT TRUNCATED AT 250 WORDS)     

Left ventricular fibroma masquerading as postinfarction myocardial rupture.

A large left ventricular fibroma was encountered perioperatively for what was presumed to be a sealed ventricular rupture after thrombolytic therapy for an acute myocardial infarction. We review the pertinent literature concerning the diagnosis of ventricular rupture and this rare benign tumor of the heart.     

Surgical treatment of cardiac fibroma in a child with left ventricular noncompaction

Surgical treatment of cardiac fibroma is rare in patients with left ventricular noncompaction (LVNC). Although several case reports regarding cardiac fibroma have been published, resection in a patient with LVNC has not been described. Here, we describe the surgical treatment of left ventricular fibroma in a child with LVNC. We resected a cardiac fibroma in a 10‐year‐old boy with LVNC to control ventricular arrhythmia. Partial resection with careful tumor dissection was performed to avoid endocardial damage and entering the ventricular cavity. The postoperative course was uneventful, and the patient remains asymptomatic without heart failure or arrhythmia. Surgical excision of cardiac fibroma can be performed safely with excellent results, even in a child with LVNC.     

ROC曲线在血液透析患者心室重构诊断中的应用

目的 运用ROC曲线探讨血清超敏C反应蛋白(hsCRP)、肿瘤坏死因子-α(TNF-α)诊断维持性血液透析(MHD)患者心室重构和微炎症状态的准确性.方法 选取2014年1月至2015年12月在我科规律透析、血液龄≥3个月、病情稳定的MHD患者100例,使用多普勒超声心动图测定左心室舒张末期内径(LVDd)、舒张末期室间隔厚度(LVST)、舒张末期左心室后壁厚度(LVPWT)等,计算左室心肌重量指数(LVMI),根据有/无发生心室重构分为观察(A,60例)组与对照(B,40例)组.检测两组患者血清hsCRP、TNF-α、甲状旁腺素(PTH)、血肌酐(Ccr)等.以hsCRP、TNF-α水平对心室重构的诊断绘制ROC曲线.结果 A组患者血清hsCRP、TNF-α、PTH、Ccr水平显著高于B组(均P＜0.05).多元线性回归分析示,A组患者hsCRP、TNF-α、PTH、Ccr与LVMI值呈正相关(F=73.62,P＜ 0.01),且hsCRP、TNF-α对LVMI值影响最大.ROC曲线示,hsCRP、TNF-α与MHD患者LVMI值关系密切,其升高程度与心室重构的严重程度呈正比.结论 血清hsCRP、TNF-α水平可反映LVMI值变化,动态观察血清hsCRP、TNF-α水平对预先判断MHD患者心室重构具有重要的临床意义.     

Surgical treatment of a left ventricular neurofibroma

Primary cardiac neurofibroma is a rare occurrence. We describe a case of left ventricular neurofibroma in a 56-year-old woman with Von Recklinghausen disease. Resection of the tumor with concomitant mitral valve replacement yielded a satisfactory clinical result, and histological examination of the resected tissue confirmed benign neurofibroma. The anatomic distribution of the vagus nerve plexus, which penetrates the epicardium and myocardium and courses over the left ventricular subendocardial surface, provides a tissue source from which this neurogenic tumor may arise.