Hemangioma of the right ventricular outflow tract

Right Ventricular Outflow Tract Obstruction in Adults: A Systematic Review and Meta-analysis

Background

Right ventricular outflow tract obstruction (RVOTO) is a cause of hemodynamic instability that can occur in several situations, including cardiac surgery, lung transplantation, and thoracic surgery, and in critically ill patients. The timely diagnosis of RVOTO is important because it requires specific considerations, including the adverse effects of positive inotropes, and depending on the etiology, the requirement for urgent surgical intervention.

Methods

The objective of this systematic review and meta-analysis was to determine the prevalence of RVOTO in adult patients, and the distribution of all reported cases by etiology.

Results

Of 233 available reports, there were 229 case reports or series, and 4 retrospective cohort studies, with one study also reporting a prospective cohort. Of 291 reported cases of RVOTO, 61 (21%) were congenital, 56 (19%) were iatrogenic, and 174 (60%) were neither congenital nor iatrogenic (including intracardiac tumour). The mechanism of RVOTO was an intrinsic obstruction in 169 cases (58%), and an extrinsic obstruction in 122 cases (42%). A mechanical obstruction causing RVOTO was present in 262 cases (90%), and 29 cases of dynamic RVOTO (10%) were reported. In the 5 included cohorts, with a total of 1122 patients, the overall prevalence was estimated to be 4.0% (1%-9%).

Conclusions

RVOTO, though rare, remains clinically important, and therefore, multicentre studies are warranted to better understand the prevalence, causes, and consequences of RVOTO.

Small cardiac hemangioma: a challenge for diagnosis and dilemma for management

A small cardiac tumor in the left ventricle was discovered incidentally in a 53-year-old patient by echocardiography and was further confirmed by magnetic resonance imaging. A clinical diagnosis of "fibroelastoma or myxoma with an atypical location?" was made, and an uneventful surgical resection was carried out in consideration of the potential embolic risk. The histologic analysis revealed a capillary hemangioma. A posteriori, we reviewed the coronary angiography performed 2 years earlier and found a typical "tumor blush" sign. We discuss the diagnostic features of this case and the alternative approaches that could have been chosen, including a conservative approach with close follow-up.

Right ventricular myxoma causing right ventricular outflow tract obstruction

Cardiac myxomas are the most common neoplasms of the heart. They can be located in any chamber of the heart but frequently in the left atrium. In this report we present a patient who had been treated for a right ventricular myxoma originating from the interventricular septum and leading to right ventricular outflow tract obstruction.

Pedicled cardiac hemangioma with right ventricular outflow tract obstruction

A 46-year-old female was admitted to our hospital complaining of dizziness. Echocardiography and magnetic resonance imaging showed a pedicled tumor in the right ventricular outflow tract (RVOT), causing severe obstruction during systole. Resection was performed under cardiopulmonary bypass. Postoperative course was uneventful, with complete disappearance of major symptoms. Histological examination revealed the nature of the tumor to be a benign hemangioma. As reports of cardiac hemangioma causing severe RVOT obstruction are extremely rare, this case warrants attention.

Cavernous hemangioma in the junction between the left atrium and the aorta: case report

We present a case of an asymptomatic cavernous hemangioma, located in the junction area between the left atrium and aorta, and our experience of diagnosis and surgical treatment of the tumor.

Cavernous hemangioma of the tricuspid valve: minimally invasive surgical resection

Cardiac hemangioma is a rare, benign vascular tumor, occurring with an incidence of 1% to 2% of all detected benign heart neoplasms. Hemangioma of the tricuspid valve has never been previously reported. We describe the successful excision of this tumor through a right anterolateral mini-thoracotomy in a 49-year-old woman. Competency of the valve was confirmed intraoperatively and at discharge by transesophageal echocardiography.