From pathogenesis to treatment, a systemic review of cardiac lipoma

Relationship between parasites and lung cancer: Unveiling the link

Lung cancer has become a significant global health concern due to the increasing number of cases and deaths. Recent research has suggested a potential link between parasites and lung cancer. This review aims to comprehensively analyse existing literature to highlight relevant studies evaluating this relationship. A thorough search in different databases revealed four key associations: parasites as a potential risk factor for lung cancer, suppressors of lung cancer, mimics of lung cancer leading to misdiagnosis, and coincidental infections with lung cancer. The review indicates a significant relationship between parasites and the suppression of lung cancer, emphasising the importance of further research to explore this novel avenue in the hope of identifying and developing novel biological cancer therapeutic and preventive strategies. It also stresses the importance of recognising pulmonary parasitic infections in the differential diagnosis of lung cancer to prevent misdiagnosis and subsequent unnecessary surgical intervention. Additionally, in patients with concurrent pulmonary parasitic infections and lung cancer, which may be easily overlooked, persistent symptoms despite applying appropriate anti-parasitic treatment should raise concern about the need for repetitive evaluation by appropriate diagnostic protocols and imaging follow-up for potential underlying lung cancer.

Cardiac osteochondrolipoma in a cheetah

A 13-y-old captive female cheetah (Acinonyx jubatus) succumbed following the acute onset of respiratory distress. Autopsy revealed bacterial bronchopneumonia as the primary cause of death. Additionally, splenic myelolipomas and systemic amyloidosis were identified postmortem. Interestingly, a solitary, firm nodule was found in the right atrial wall, consisting histologically of mature adipocytes with partial osseous and cartilaginous differentiation, consistent with osteochondrolipoma. Hepatic congestion suggested right heart failure. Although the direct impact of the cardiac mass on heart function remains unclear, its potential contribution to the fatal outcome cannot be discounted. To our knowledge, cardiac osteochondrolipoma has not been reported previously in cheetahs or other animals.

An epicardial problem case report: multimodality imaging assessment of a patient presenting with symptomatic ventricular tachycardia, secondary to a large, epicardial, lipomatous mass with myocardial infiltration

Background

Cardiac lipomas are considered benign and slow-growing adipose tissue tumours; however, the size and location can cause significant haemodynamic compromise and therefore can be malignant in clinical presentation.

Case summary

The clinical case describes a rare presentation of a 50-year-old patient, presenting with recurrent haemodynamically compromising ventricular arrhythmia; secondary to an incredibly large, epicardial lipomatous mass, with associated combination of myocardial infiltration, left ventricular systolic impairment, and complex cardiac circulatory involvement.

Discussion

The case illustrates the ESC guidelines on the benefits of complimentary multimodality cardiac imaging to assess complex pericardial disease, to improve both clinical understanding and management.

Atypical Primary Cardiac Tumor Engulfing Papillary Muscle of the Tricuspid Valve

Primary cardiac tumors are exceedingly rare and typically benign yet can potentially cause life-threatening complications. These tumors are often asymptomatic, making diagnosis challenging and frequently incidental. We present a rare case of a primary cardiac tumor with unusual features that do not perfectly align with any specific recognized entity.

Size and Illumination Matters: Local Magnetic Actuation and Fluorescence Imaging for Microrobotics

Combining local magnetic actuation with fluorescence imaging modalities promises to introduce significant advances in microrobotic-guided procedures. This review presents the advantages and challenges of this approach, emphasizing the need for careful design considerations to optimize performance and compatibility. Traditional microrobotic actuation systems rely on bulky electromagnets, which are unsuitable for clinical use due to high power requirements and limited operational workspace. In contrast, miniaturized electromagnets can be integrated into surgical instruments, offering low power consumption and high actuation forces at the target site. Fluorescence imaging modalities have been explored in microrobotics, showcasing spatiotemporal resolution and the capability to provide information from biological entities. However, limitations, such as shallow penetration depth and out-of-focus fluorescence, have motivated the development of advanced techniques such as two-photon microscopy. The potential of two-photon microscopy to overcome these limitations is highlighted, with supporting evidence from previous studies on rat tissue samples. Current challenges in optical penetration depth, temporal resolution, and field of view are also addressed in this review. While integrating miniaturized electromagnets with fluorescence imaging modalities holds the potential for microrobotic-guided procedures, ongoing research and technological advancements are essential to translating this approach into clinical practice.

Butterfly-Shaped Epicardial Lipoma of the Heart

Cardiac tumors are a rare entity with typically unspecific symptoms. We present the case of a 43-year old female patient with epigastric pain and palpitations with a long history of diagnostics prior to discovery of an epicardial mass. The epicardial tumor with arterial vascularization from the left anterior descending artery was resected in a beating heart procedure and was found to be a lipomatous soft tissue tumor. A lack of mouse double minute 2 gene amplification in fluorescent in situ hybridization confirmed the diagnosis of a benign cardiac lipoma. Resection led to a long-term resolution of symptoms.

Cardiac Computed Tomography as a Method of Diagnosing the Type of Cardiac Tumor-Example of Interatrial Septal Lipoma Filling the Right Atrium

Cardiac tumors present substantial diagnostic challenges due to their diverse manifestations and similarity to other cardiac pathologies. Cardiac lipomas are rare tumors that originate from adipose cells and can develop in any location within the heart. Cardiac lipomas account for 2.4% of all primary cardiac tumors. Most lipomas are located within the cardiac chambers. Among the lipomas occurring within the cardiac chambers, the most common localization is the right atrium. Currently, the gold standard for imaging cardiac tumors is cardiac magnetic resonance (CMR). Despite the significant advantages of CMR, cardiac computed tomography angiography (CCTA) continues to be a valuable technique when CMR is either unavailable or contraindicated. In some cardiac tumors, CCTA can identify the type of tumor. A classic example of this type is a lipoma. We present images of a large interatrial septal lipoma filling the right atrium diagnosed by CCTA in a 57-year-old female Caucasian patient. In summary, CCTA effectively identifies lipomas' characteristic features and provides crucial information for appropriate management.

Report of a giant invasive, wall-penetrating cardiac lipoma

BACKGROUND

Cardiac lipoma, a seldom-encountered benign tumor positioned beneath the endocardium, has the potential to impair electrophysiological functions. Diagnosis is principally based on imaging modalities. The uniqueness of this case lies in the tumor's extension both internally and externally within the right atrium, rendering it of special interest. From a clinical standpoint, surgical removal is commonly advocated, wherein early intervention is pivotal in improving patients' long-term prognoses.

CASE PRESENTATION

A 35-year-old male was admitted to the hospital for treatment subsequent to the identification of a cardiac mass two days prior. Initial diagnostic assessments, encompassing CT scans and echocardiography, identified a space-occupying lesion within the heart. The patient underwent surgical excision of the cardiac tumor, utilizing mild hypothermic extracorporeal circulation via femoral vessel access. Intraoperative findings revealed adipose-like tissue of a "dumbbell-shaped" configuration situated both within and external to the right atrium, measuring approximately 8 cm*9 cm internally and 7 cm*6 cm externally, with the extracardiac mass being marginally larger. Postoperative pathological analysis confirmed a cardiac lipoma diagnosis. A follow-up echocardiogram conducted three months post-surgery exhibited no notable abnormalities. The patient is under continuous observation to monitor for any recurrence or potential long-term complications.

CONCLUSION

In this case report, we detail with precision a rare cardiac pathology manifested by an expansive infiltrative lipoma that pervades the endocardial and epicardial layers of the right atrium. After thorough preoperative diagnostic workup and evaluation, we contend that surgical intervention represents the optimal therapeutic approach for managing such conditions, with the goal of preemptively reducing the likelihood of cardiac compression or intracardiac obstruction.

A Cadaveric Case Report of a Rare Atrial Septal Lipoma

Primary cardiac tumors (PCTs) are rare and include myxomas, papillary fibroelastomas, rhabdomyomas, and lipomas. Lipomatous hypertrophy of the atrial septum (LHAS) is a benign condition associated with aging and obesity that is marked by fat accumulation in the interatrial septum and is caused by hyperplasia of adipose cells. In contrast, lipomas are characterized as soft masses of fat that are encapsulated by thin, fibrous tissue. True cardiac lipomas are rare and can present a diagnostic dilemma. Cardiac lipomas are generally asymptomatic but may present with angina, dyspnea, or syncope. Less frequently, they can cause arrhythmias, valve dysfunction, or emboli. Diagnosis generally requires cardiac MRI or alternate imaging modality. In this report, we present a case of a true atrial septal lipoma with a sessile base protruding into the right atrium discovered during the pedagogic dissection assignment of the interior of the heart. The tumor measured 0.5 × 1.0 cm, and on the cut surface, it appeared yellow and encapsulated. Histopathological examination of the lipomatous mass revealed extensive nodular thickening of the interatrial septum from the accumulation of mature adipose tissue reaching the resection surface. It is possible that the lipoma may have had a space-occupying effect, which would have increased the volume within the right atrium and had an adverse effect on tricuspid valve function. This is consistent with the dilated and thin-walled appearance of the right atrium. This report contributes to the limited literature on this type of benign, primary cardiac tumor and provides a clear illustration and clinical relevance to showcase the pathology and its possible clinical consequences.

Cardiac Tumors: Review

Cardiac tumors are rare and encompass a variety of presentations. Clinica symptoms are usually nonspecific, but they can present as obstructive, embolic, or constitutional symptoms. Treatment options and prognosis vary highly depending on the subtype, tumor size, and location. Surgical resection is usually the first-line therapy, except for cardiac lymphomas, and provides favorable long-term prognosis in most benign tumors. Cardiac sarcomas, however, are usually diagnosed in advanced stages, and the treatment relies on a multimodal approach with chemotherapy and radiotherapy. Metastatic cardiac tumors are usually related to advanced disease and carry an overall poor prognosis.

Incidental Cardiac Lipoma in a Pediatric Patient

Cardiac lipomas are primary benign tumors of the heart, consisting mainly of fat cells and the capsule surrounding them. They are rare, usually detected incidentally, and are mostly asymptomatic or may cause symptoms depending on their location. In this case, we planned to present a 13-year-old male patient who was diagnosed with cardiac lipoma, had echocardiography follow-up at regular intervals, and was treated symptomatically. Although cardiac magnetic resonance imaging and histopathological diagnosis are required to confirm the diagnosis of cardiac lipoma, resection may not be necessary due to the location of the mass and the fact that it does not cause any life-threatening symptoms, as in our patient.

The Impact of Addictions Management Following Cardiac Surgery on People Who Inject Drugs and Have Infective Endocarditis

Background

Managing reinfection in patients who inject drugs and have undergone cardiac surgery could reduce mortality. A significant gap exists in the management of addiction in this population and it is rarely addressed during index hospitalization for surgical intervention. This study sought to determine if management of addiction changed rates of readmission for reinfection.

Methods

This study was a retrospective chart review and analysis. Patients who underwent cardiac surgery for infective endocarditis due to injection drug use underwent a full chart review to determine if they received management of their addiction (addictions medicine consultation, social work consultation, medication- and/or opioid-assisted treatment, and community follow-up) following their surgical intervention.

Results

A total of 41 patients were identified who met the inclusion criteria. For addictions management, 43.2% of patients received an addictions medicine consultation, 67.6% received a social work consultation, 40.5% received medication- and/or opioid-assisted treatment, and 56.8% received community follow-up. Overall mortality of these patients was 21.6%, and 56.8% of patients were readmitted with reinfection. Multivariate logistic regression showed that patients who received intervention were 1.6 times more likely to be readmitted with reinfection (odds ratio 1.65, 95% confidence interval 0.29-9.41, P = 0.5736). Female patients had a significantly higher odds of reinfection, when adjusted for gender (odds ratio 9.95, 95% confidence interval 1.42-69.72, P = 0.021).

Conclusions

We demonstrated a nonstandardized approach to consultation and varying approaches to management of addiction. Patients who received intervention for addiction were more likely to be readmitted for reinfection, but this difference was not significant. Future efforts can include promotion of formalized addictions consultation services for high-risk patients.

Multimodality Imaging in Right Heart Tumors: Proposed Algorithm towards an Appropriate Diagnosis

A right heart tumor can be identified by transthoracic echocardiography during a routine examination or due to cardiac symptoms. The first step is the assessment by echocardiography, with its multiple techniques, and the obtained information must be judged in a clinical and biological context. The second step comprises one, sometimes even two, of the more complex modality imaging methods. The choice is driven not only by the advantages of each imaging technique but also by local expertise or the preferred imaging modality in the center. This step is followed by staging, follow-up, and/or imaging-guided excision or biopsy, which is performed in selected cases in order to obtain anatomopathological confirmation. In the presence of features suggestive of malignancy or causing hemodynamic impairment, a transvenous biopsy is essential before the more complex imaging modalities (which are still relevant in the staging process). Using a structured imaging approach, it is possible to reach an appropriate diagnosis without a biopsy. Frequently, these imaging techniques have a complementary role, so an integrated imaging approach is recommended. This proposed algorithm for appropriate diagnosis of right heart tumors could serve as a practical guide for clinicians (not only imaging specialists).

SPP1, a potential therapeutic target and biomarker for lung cancer: functional insights through computational studies

NIH reported 128 different types of cancer of which lung cancer is the leading cause of mortality. Globally, it is estimated that on average one in every seventeen hospitalized patients was deceased. There are plenty of studies that have been reported on lung cancer draggability and therapeutics, but yet a protein that plays a central specific to cure the disease remains unclear. So, this study is designed to identify the possible therapeutic targets and biomarkers that can be used for the potential treatment of lung cancers. In order to identify differentially expressed genes, 39 microarray datasets of lung cancer patients were obtained from various demographic regions of the GEO database available at NCBI. After annotating statistically, 6229 up-regulated genes and 10324 down-regulated genes were found. Out of 17 up-regulated genes and significant genes, we selected SPP1 (osteopontin) through virtual screening studies. We found functional interactions with the other cancer-associated genes such as VEGF, FGA, JUN, EGFR, and TGFB1. For the virtual screening studies,198 biological compounds were retrieved from the ACNPD database and docked with SPP1 protein (PDBID: 3DSF). In the results, two highly potential compounds secoisolariciresinol diglucoside (-12.9 kcal/mol), and Hesperidin (-12.0 kcal/mol) showed the highest binding affinity. The stability of the complex was accessed by 100 ns simulation in an SPC water model. From the functional insights obtained through these computational studies, we report that SPP1 could be a potential biomarker and successive therapeutic protein target for lung cancer treatment.

A Frailty Index to Predict Mortality, Resource Utilization and Costs in Patients Undergoing Coronary Artery Bypass Graft Surgery in Ontario

Background

People living with frailty are vulnerable to poor outcomes and incur higher health care costs after coronary artery bypass graft (CABG) surgery. Frailty-defining instruments for population-level research in the CABG setting have not been established. The objectives of the study were to develop a preoperative frailty index for CABG (pFI-C) surgery using Ontario administrative data; assess pFI-C suitability in predicting clinical and economic outcomes; and compare pFI-C predictive capabilities with other indices.

Methods

A retrospective cohort study was conducted using health administrative data of 50,682 CABG patients. The pFI-C comprised 27 frailty-related health deficits. Associations between index scores and mortality, resource use and health care costs (2022 Canadian dollars [CAD]) were assessed using multivariable regression models. Capabilities of the pFI-C in predicting mortality were evaluated using concordance statistics; goodness of fit of the models was assessed using Akakie Information Criterion.

Results

As assessed by the pFI-C, 22% of the cohort lived with frailty. The pFI-C score was strongly associated with mortality per 10% increase (odds ratio [OR], 3.04; 95% confidence interval [CI], [2.83,3.27]), and was significantly associated with resource utilization and costs. The predictive performances of the pFI-C, Charlson, and Elixhauser indices and Johns Hopkins Aggregated Diagnostic Groups were similar, and mortality models containing the pFI-C had a concordance (C)-statistic of 0.784. Cost models containing the pFI-C showed the best fit.

Conclusions

The pFI-C is predictive of mortality and associated with resource utilization and costs during the year following CABG. This index could aid in identifying a subgroup of high-risk CABG patients who could benefit from targeted perioperative health care interventions.

Cardiac lipoma in a young lady

Key Clinical Message

To confirm the diagnosis of cardiac lipomas, it is crucial to use multimodality imaging and also histopathology examination if the patient underwent surgery. But surgery is not needed in many cases unless there are life-threatening situations.

Abstract

Cardiac lipoma is a rare condition which is believed as a benign tumor; here, we want to present a case of young adult lady who came to our hospital complaining of chest pain and diagnosed cardiac mass by echocardiography that underwent cardiac MRI which showed cardiac lipoma and managed conservatively by serial echocardiography.

Pulmonary valve spindle-cell lipoma: A case report

Primary cardiac tumours are rare and most of them are benign. Myxomas, fibroelastomas and lipomas are common in adults. Primary valvular cardiac tumours are even more rare and affect all four valves in a similar proportion. Valvular lipomas are very rare. In the pulmonary valve there is only one described. Lipomas can be spindle-cell varieties. But of these, there is only one described in a valve, and it is placed in the aortic valve. Pulmonary valve lipomas can produce obstruction to the right ventricular outflow tract as well as pulmonary valve regurgitation, or pulmonary embolism. Symptoms may be dyspnoea, angina, arrhythmias, or syncope. We aim to illustrate with this case report how we came into this very rare pathology, so we present a 54-year-old woman with a giant spindle-cell lipoma located in the anterior pulmonary leaflet and severe dyspnoea. Total resection of the tumour was performed and restoration of valve function was obtained by means of bicuspidization of the remaining pulmonary leaflets. She had a good recovery after surgery and no complication during the postoperative evolution, being discharged from hospital after 7 days from surgery, with echocardiographic control showing good biventricular function, absence of tumour or obstruction, and minimal pulmonary valve regurgitation.

An Intramyocardial Lipoma Mimicking Post-infarction Fatty Changes: Discussion of Key Distinguishing Imaging Findings and Clinical Implications

Cardiac lipomas are benign primary cardiac tumors that are most often asymptomatic and diagnosed incidentally. Cardiac magnetic resonance imaging (MRI) is the imaging modality of choice when aiming to characterize these tumors. A minority of cardiac lipomas are intramyocardial, which, when combined with the much more common post-infarction fatty metaplasia, makes diagnosing these lipomas very challenging. We review a case of intramyocardial lipoma in the distal interventricular septum that was initially detected on a low-dose computed tomography for lung cancer screening and the subsequent findings on cardiac MRI that made the diagnosis. Additionally, this case also helps to support the conservative management of intramyocardial lipomas that are more distal in the left ventricle and subsequently at lower risk for conduction arrhythmias.

Presentation and treatment of two massive intrapericardial lipoma. Case report

INTRODUCTION AND IMPORTANCE

Primary pericardial tumors are very rare with an overall incidence of 0.001-0.007 % and account for approximately 10 % of heart neoplasms. We present two clinical cases of massive mature intrapericardial lipomas (maximum size 270 × 230 mm) that were successfully treated in our department.

CASE PRESENTATION

The first case is that of a 67-year-old male patient who underwent diagnostic investigations after the onset of dyspnea, which confirmed an intrapericardial mass of 270 × 230 mm in size that extended into the left lung field and was treated surgically by a clamshell incision. The second case is that of a 48-year-old patient who was completely asymptomatic and occasionally confirmed to have a 170 × 110 mm intrapericardial mass around the heart, which was surgically removed via sternotomy, also resulting in a mature lipoma.

CLINICAL DISCUSSION

In asymptomatic patients with small lesions, close monitoring is generally indicated. In asymptomatic patients with large lesions the decision should be made after multidisciplinary (MDT) evaluation. In symptomatic patients, surgical treatment is indicated. Lipomas are usually mature lesions with a capsule connected to the origin structure by one or more pedicles. Once reached the cardiac level and opened the pericardium, attention must be paid in resecting these pedicles given the area of origin and the possibility that they may be associated with vital structures.

CONCLUSION

Both cases were characterized by slow recovery of normal cardiac function in the postoperative course. The average length of patient stay was 12 days, and one case was noted for readmission because a slight increase in pericardial effusion was detected at the scheduled ultrasound check after discharge. After further expert evaluation and steriodine therapy, the patient was discharged to a healthy home after 5 days. This report aims to describe the decision-making process, successful surgical treatment and outcomes of two rare massive intrapericardial tumors.

Cardiac and Pericardial Neoplasms in Children: Radiologic-Pathologic Correlation

Primary cardiac and pericardial neoplasms are rare in the pediatric population and can include both benign and malignant lesions. Rhabdomyomas, teratomas, fibromas, and hemangiomas are the most common benign tumors. The most common primary cardiac malignancies are soft-tissue sarcomas, including undifferentiated sarcomas, rhabdomyosarcomas, and fibrosarcomas. However, metastatic lesions are more common than primary cardiac neoplasms. Children with primary cardiac and pericardial tumors may present with nonspecific cardiovascular symptoms, and their clinical presentation may mimic that of more common nonneoplastic cardiac disease. The diagnosis of cardiac tumors has recently been facilitated using noninvasive cardiac imaging. Echocardiography is generally the first-line modality for evaluation. Cardiac MRI and CT are used for tissue characterization and evaluation of tumor size, extension, and physiologic effect. The varied imaging appearances of primary cardiac neoplasms can be explained by their underlying abnormality. Treatment of these lesions varies from conservative management, with spontaneous regression of some lesions such as rhabdomyomas, to surgical resection, particularly in patients with associated heart failure. With adequate imaging techniques and knowledge of the pathologic basis of the neoplasm, it is often possible to differentiate benign from malignant tumors, which can greatly affect adequate and timely treatment. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.

MR imaging of primary benign cardiac tumors in the pediatric population

Primary cardiac tumors are rare in all ages, especially in children, with a reported prevalence range of 0.0017-0.28% in autopsy series. Due to their rarity, the diagnostic and therapeutic pathways reserved to them are usually described by single case reports, leading to the point where a common diagnostic protocol is imperative to obtain a differential diagnosis. The first diagnostic approach is done with transthoracic echocardiogram (TTE), due to its wide availability, low cost, absence of ionizing radiations and non-invasiveness. Several tumors are discovered incidentally and, in many cases, TTE is helpful to determine location, size and anatomical features, playing a key role in the differential diagnosis. In the last few years, cardiac magnetic resonance imaging (CMR) has had an increased role in the diagnostic pathway of pediatric cardiac masses, due to its high accuracy in characterizing mass tissue properties (especially for soft tissue), and in detecting tumor size, extent, pericardial/pleural effusion, leading to the correct diagnosis, treatment and follow-up. Therefore, nowadays, several consensus statements consider CMR as a leading imaging technique, thanks to its non-invasive tissue characterization, without the use of ionizing radiation, in an unrestricted field of view. As suggested by the most recent literature, the pediatric protocol is not so different from the adult one, adapted to the size and cardiac frequency of the patient, sometimes requiring special conditions such as free-breathing sequences and/or sedation or general anesthesia in non-cooperating patients.

Papillary Muscle Lipoma in a Teenage Patient With Review of the Literature

•Cardiac lipoma is exceedingly rare in both adult and pediatric populations. •Only a few cases of papillary muscle lipoma have been reported. •TTE is the first step in detecting a cardiac mass. •CMR contributes to the diagnosis of cardiac lipoma. •There are no specific guidelines for the treatment of papillary muscle lipoma.

Cardiac Masses Discovered by Echocardiogram; What to Do Next?

Cardiac tumors are rare conditions, typically diagnosed on autopsy, but with the advancement of imaging techniques they are now encountered more frequently in clinical practice. Echocardiography is often the initial method of investigation for cardiac masses and provides a quick and valuable springboard for their characterization. While some cardiac masses can be readily identified by echocardiography alone, several require incorporation of multiple data points to reach diagnostic certainty. Herein, we will provide an overview of the main clinical, diagnostic, and therapeutic characteristics of cardiac masses within the framework of their location.

Effect of Gender on Postoperative Outcome and Duration of Ventilation After Coronary Artery Bypass Grafting (CABG)

INTRODUCTION

The study assessed coronary artery bypass grafting (CABG) postoperative outcomes and associated factors in Saudi male and female patients. This was a retrospective cohort of patients who underwent CABG at the King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, from January 2015 to December 2022.  Results: We included 392 patients, of whom 63 (16.1%) were female. Female undergoing CABG were significantly older (p=0.0001), had a significantly higher incidence of diabetes (p=0.0001), obesity (p=0.001), hypertension (p=0.001), and congestive heart failure (p=0.005), with a smaller body surface area (BSA) (p=0.0001) than male. Though renal dysfunction, previous cerebrovascular accident/transient ischemic attack (CVA/TIA), and myocardial infarction (MI), incidences were similar in both genders. Females were at significantly higher risk of mortality (p=0.0001), longer hospital stay (p=0.0001), and prolonged ventilation (p=0.0001). Preoperative renal dysfunction was the only statistically significant predictor of postoperative complications (p=0.0001). Female gender and preoperative renal dysfunction, were significant independent predictors of postoperative mortality and prolonged ventilation (p=0.005).

CONCLUSION

This study's findings indicated that females have worse CABG outcomes and a higher risk of morbidities and complications. Uniquely our study showed a higher incidence of prolonged ventilation in females postoperatively.

Surgical treatment of cardiac lipoma: 20 years' experience in a single center

BACKGROUND

Primary cardiac lipoma is very rare, and no consensus has been developed regarding its ideal treatment strategy. This study reviewed the surgical treatment of cardiac lipomas in 20 patients over 20 years.

METHODS

Twenty patients with cardiac lipomas were treated at Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College from January 1, 2002, to January 1, 2022. The patients' clinical data and pathological reports were retrospectively analyzed, and the follow-up with a range of 1 year to 20 years was conducted.

RESULTS

The cardiac lipomas were located in the right atrium (RA) or superior vena cava (SVC) in seven patients (35%) (RA in six patients and SVC in one patient), left ventricle in eight patients (40%) (left ventricular chamber in four patients and left ventricular subepicardium and myocardium in four patients), right ventricle in three patients (15%) (right ventricular chamber in one patient and right ventricular subepicardial layer and myocardium in two patients), subepicardial interventricular groove in one patient (5%), and pericardium in one patient (5%). Complete resection was achieved in 14 patients (70%), including seven patients with lipomas in the RA or SVC. Incomplete resection occurred in six patients (30%) with lipomas in the ventricles. No perioperative deaths occurred. Long-term follow-up was conducted for 19 patients (95%), including two (10%) who died. Both patients who died had lipomas incompletely resected due to ventricles involvement, and preoperative malignant arrhythmias persisted post-operatively.

CONCLUSIONS

The complete resection rate was high, and the long-term prognosis was satisfactory in patients with cardiac lipomas that did not involve the ventricle. The complete resection rate was low in patients with cardiac lipomas in ventricles; and complications, including malignant arrhythmia, were common. Failure of complete resection and post-operative ventricular arrhythmia are correlated with post-operative mortality.

Common benign primary pediatric cardiac tumors: a primer for radiologists

Cardiac tumors are neoplasms arising from or located in the heart or the pericardium. Although rare, primary cardiac tumors in children require an accurate and timely diagnosis. Most pediatric primary cardiac tumors are benign (around 90%). Echocardiography is the first imaging modality used due to its availability, noninvasiveness, inexpensiveness, and absence of ionizing radiation. Computed tomography (CT) and magnetic resonance imaging (MRI) offer better soft tissue visualization as well as better visualization of extracardiac structures. A great advantage of MRI is the possibility of measuring cardiac function and blood flow, which can be important for obstructing cardiac tumors. In this article, we will offer a brief review of clinical, echocardiographic, CT, and MRI features of cardiac rhabdomyomas, fibromas, teratomas, and lipomas providing their differential diagnosis.

Clinically atypical abdominal manifestation of the lipoma localized in the right atrium: "Invagination hypothesis" revisited

Cardiac lipomas are the second most common cardiac tumors. They are usually asymptomatic and diagnosed as incidental findings. We describe a 71-year-old patient with a tumor in the right atrium. In echocardiography and MRI scan, the diagnosis of a cardiac lipoma was suspected. Moreover, MRI demonstrated continuity of pericardial fat and the tumor in the right atrium by infolding of the atrial wall and epicardial adipose tissue in the space between the atrial walls, which might be a hint for the Waterstone groove hypothesis. An operative resection was performed which confirmed the suspected diagnosis.

Giant Intracardiac Lipoma: A Case Report and the Role of Multimodality Cardiac Imaging

Cardiac lipomas, especially ones originating from the left ventricle, are extremely rare. They may be asymptomatic or may present with various non-specific symptoms. Herein, we report a case of a giant lipoma of the left ventricle, with frequent ventricular premature beats on electrocardiogram. An echocardiogram demonstrated a large hyperechoic mass occupying a significant portion of the left ventricle. We further describe the diagnostic workup utilizing multimodality cardiac imaging and treatment options. Cardiac MRI demonstrated fat suppression, and cardiac CT showed a homogenous low-attenuation mass suggesting lipomatous matter. The mass was subsequently surgically removed for pathology examination in order to rule out liposarcoma. Histopathology demonstrated mature adipocytes, entrapped myocytes with hypertrophy, and interstitial fibrosis foci confirming the diagnosis of lipoma.

Multimodality cardiac imaging in the diagnostic approach to chronic dyspnea: a patient with pericardial lipoma

Cardiac masses are rare entities that present with a very varied spectrum of manifestations ranging from asymptomatic to severe hemodynamic compromise. They mainly correspond to benign neoplastic lesions; however, other pathologies may occur. The availability of high-definition imaging techniques has increased early detection. Nevertheless, these techniques do not allow the characterization and reliable differentiation of the nature of the mass. We describe a patient with no cardiovascular history with a chronic dyspnea, in whom the presence of a cardiac mass attached to the ventricle with slight deformation of the right cavities was identified by imaging studies. The patient underwent surgical resection, which confirmed the presence of lipoma by histopathology. This finding is the rarest of all benign cardiac tumors.

An Uncommon Cause of Dyspnea: Usefulness of Multimodality Cardiac Imaging

Pericardial lipomas are very uncommon benign primary cardiac tumors. We describe the case of a patient with symptomatic large pericardial mass who presented with heart failure. Multimodality cardiac imaging helped us in the diagnosis of this unusual entity. (Level of Difficulty: Intermediate.).

Total endoscopic left ventricle lipoma removal

Background

Left ventricle (LV) lipoma is a very rare, benign cardiac tumor. Due to its rarity, LV lipoma is often misdiagnosed. Aspecific symptoms such as murmurs, arrhythmias, memory loss and palpitation may occur due to the mass effect.

Case presentation

We report a case report of a 42 year old woman who was found to have left ventricle mass after check-up for arrhytmia. By a fully endoscopic approach, the mass was successfully resected from the left ventricle without the need for sternotomy.

Conclusion

Total endoscopic removal of left ventricle lipoma’s can be done safely and has several advantages to conventional sternotomy. Larger studies are needed to confirm this hypothesis.

Multiple lipomata of the tricuspid valve and papillary muscle: case report

Background

Cardiac lipomas are rare benign primary tumours of the heart. Due to the nature of these tumours, they are often asymptomatic and diagnosed incidentally. Whether asymptomatic patients with cardiac lipomas should perform surgery still remains controversial.

Case summary

A 34-year-old Asian male who was incidentally found hyperechoic masses in the right ventricle (RV) on the transthoracic echocardiogram by annually routine physical examination was admitted to our cardiology department. His medical history was unremarkable. The repeated transthoracic and transoesophageal echocardiogram showed multiple solitary and well-demarcated masses in the RV. On the cardiac magnetic resonance imaging, four discrete masses (considering the possibility of it being a lipoma) partially occluding the right ventricular outflow tract (RVOT) were observed. During the open-heart resection surgery, it was found that the tricuspid valve and papillary muscle were covered by multiple adipose masses in the RV that arose from the interventricular septum and the free wall, resulting in partial RVOT obstruction. These excised masses were histopathologically confirmed as lipomata characterized by the mature adipocytes with entrapped myocardial cells. The patient had no cardiac abnormality in the 1-month follow-up after the surgery.

Discussion

This rare clinical case of multiple lipomata of the tricuspid valve and papillary muscle acknowledges that multimodality imaging is the cornerstone for the assessment and diagnosis. Surgery should be performed in cases of symptomatic or large lipomas as well as when a lipoma is considered to be high risk because of RVOT obstruction.

The value of multimodality imaging in diagnosis and treatment of cardiac lipoma

Background

Cardiac lipoma is a rare primary tumor in the heart and pericardium. Multimodality imaging methods, especially magnetic resonance imaging (MRI), are crucial in detecting and diagnosing cardiac lipomas. Besides, they are of significant importance in management of cardiac lipomas. The aim of this study was to evaluate the value of multimodality imaging methods in diagnosing and treatment of cardiac lipoma by describing a series of cases of cardiac lipoma.

Materials and methods

Data of patients with cardiac lipoma at a local institution were retrospectively collected. Their imaging findings on echocardiography, computed tomography (CT), and cardiac MRI and clinical management were described in detail.

Results

12 patients with cardiac lipoma were retrospectively included with thirteen lipomas found within heart and pericardium. Two patients’ lipoma were symptomatic, while lipomas in other 10 patients were found incidentally. Most lipomas were sensitively detected with echocardiography. Accurate diagnoses were achieved with CT and MRI in all cases. Surgical resection was performed in one symptomatic patient due to the obstruction of the left ventricular outflow tract, while the removal of pericardial lipoma in another symptomatic patient was not possible due to diffuse myocardial infiltration observed in MRI. Based on MRI findings, two patients without clinical symptoms also underwent surgery to prevent the risk of detachment of ventricular lipoma with a narrow pedicle in one patient and potential further thinning of the myocardium by pericardial lipoma growth in another patient.

Conclusions

Cardiac lipoma could be sensitively detected and accurately diagnosed with multiple noninvasive imaging tools. Comprehensive evaluation with multimodality imaging methods should also be conducted for better management planning and follow-up in all patients.