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Sauchelli-Faas G, Barragán-Acea A, Álvarez-Argüelles H, Montoto-López J, Jiménez-Rivera JJ, Martínez-Sanz R. Pulmonary valve spindle-cell lipoma: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231216544. [PMID: 38033915 PMCID: PMC10687942 DOI: 10.1177/2050313x231216544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023] Open
Abstract
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.
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Affiliation(s)
- Guadalupe Sauchelli-Faas
- Cardiovascular Surgery Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Antonio Barragán-Acea
- Echocardiography Unit, Cardiology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Hugo Álvarez-Argüelles
- Pathology Department, Hospital Universitario de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Javier Montoto-López
- Cardiovascular Surgery Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | - Rafael Martínez-Sanz
- Cardiovascular Surgery Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
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D’Anna C, Villani A, Ammirati A, Francalanci P, Ragni L, Cecconi G, Secinaro A, Chinali M, Santilli A, Guccione P, Galletti L, Brancaccio G. New Onset Cardiac Murmur and Exertional Dyspnea in an Apparently Healthy Child: A Rare Localization of Obstructive Myxoma in the Right Ventricle Outflow Tract without Pulmonary Embolization-A Case Report and Literature Review. Int J Environ Res Public Health 2022; 19:12888. [PMID: 36232202 PMCID: PMC9566503 DOI: 10.3390/ijerph191912888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Myxomas are slowly growing benign neoplasms which are rare in children. Up to 80% can be located in the left atrium and generate symptoms such as embolism, cardiac failure, fever and weight loss. Rarely, myxomas can be detected in the right ventricle outflow tract, causing arrhythmias, pulmonary emboli and sudden death. We report the case of a 13-year-old healthy child brought to the Emergency Department (ED) of the Children's Hospital Bambino Gesù, Rome, for recent dyspnea, chest pain on exertion and new onset cardiac murmur. Patient underwent medical examination and echocardiogram with the finding of a rounded and lobulated voluminous mass in the right ventricle outflow tract (RVOT) which caused severe obstruction. The contrast computed tomography (CT) scan confirmed the presence of a heterogeneously enhancing soft-tissue mass occupying the RVOT with no evidence of pulmonary embolization. The mass was surgically excised, and the pathologic examination confirmed our suspicion of myxoma. Our experience suggests that myxoma can have mild clinical symptoms, the presentation may be non-specific, and diagnosis can be a challenge Careful examination and a diagnostic imaging workup, primarily with the transthoracic echocardiogram, are needful to make a rapid differential diagnosis and to better manage surgical treatment and follow-up.
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Affiliation(s)
- Carolina D’Anna
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Alberto Villani
- Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Antonio Ammirati
- Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Paola Francalanci
- Department of Pathological Anatomy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Laura Ragni
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Giulia Cecconi
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Aurelio Secinaro
- Advanced Cardiovascular Imaging Unit, Department of Imaging, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | - Marcello Chinali
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Antonella Santilli
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Paolo Guccione
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Lorenzo Galletti
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Gianluca Brancaccio
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
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Parollo M, Levantino M, Pucci A, Aquaro GD, Delle Donne MG, Caravelli P, Capozza P, Colli A, De Caterina R. A unique case of right ventricular myxoma concealed within a thrombus in a patient with Crohn's disease: a problem unresolved even with advanced cardiac MRI. J Cardiovasc Med (Hagerstown) 2022; 23:272-274. [PMID: 35287159 DOI: 10.2459/jcm.0000000000001301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Angela Pucci
- U.O. Anatomia Patologica 3, Azienda Ospedaliero-Universitaria Pisana
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Abstract
Right ventricular (RV) myxoma is a very rare finding. Its differential diagnosis includes cardiac thrombus, and its risk of life-threatening complications mandates early diagnosis followed by surgical resection. We report the case of a patient with an incidental RV mass and a difficult differential diagnosis. A 66-year-old woman, first assessed in neurosurgery due to a lumbar herniated disc, was referred to cardiology for examination before proceeding to surgery. She complained of dyspnea on exertion present for the last few months and reported no fainting or syncope. Clinical examination showed intermittent pulmonary systolic murmur. Transthoracic echocardiography revealed an oval-shaped sessile mobile mass (42∕18 mm) attached to the anterior RV wall. Computed tomography confirmed the presence of a RV mass with lower attenuation than the myocardium and extension towards the pulmonary trunk, without other abdominal or pulmonary masses that would suggest a thrombus. Cardiac magnetic resonance imaging described an ovoid mass (47∕16 mm) in the right ventricle, "clinging" to the apical trabeculae, swinging during the cardiac cycle, causing partial obstruction of the pulmonary valve during systole. The patient underwent surgical resection of the tumor. Macroscopic specimen showed a translucent polypoid mass with hemorrhagic areas. Microscopy confirmed the diagnosis of RV myxoma. The case illustrates the difficulty of establishing the correct etiological diagnosis of a cardiac mass, especially when located in the right ventricle. Multimodality imaging remains the cornerstone of noninvasive tissue characterization of cardiac masses, still requiring histopathological confirmation, particularly in the setting of conflicting imaging results.
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Affiliation(s)
- Ana Maria Balahura
- Clinical Department No. 5, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Clinical Emergency Hospital Bucharest, Romania; ,
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Villafane J, Miller JR, Glickstein J, Johnson JN, Wagner J, Snyder CS, Filina T, Pomeroy SL, Sexson-Tejtel SK, Haxel C, Gottlieb J, Eghtesady P, Chowdhury D. Loss of Consciousness in the Young Child. Pediatr Cardiol 2021; 42:234-254. [PMID: 33388850 DOI: 10.1007/s00246-020-02498-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/07/2020] [Indexed: 01/03/2023]
Abstract
In the very young child (less than eight years of age), transient loss of consciousness represents a diagnostic and management dilemma for clinicians. While most commonly benign, syncope may be due to cardiac dysfunction which can be life-threatening. It can be secondary to an underlying ion channelopathy, cardiac inflammation, cardiac ischemia, congenital heart disease, cardiomyopathy, or pulmonary hypertension. Patients with genetic disorders require careful evaluation for a cardiac cause of syncope. Among the noncardiac causes, vasovagal syncope is the most common etiology. Breath-holding spells are commonly seen in this age group. Other causes of transient loss of consciousness include seizures, neurovascular pathology, head trauma, psychogenic pseudosyncope, and factitious disorder imposed on another and other forms of child abuse. A detailed social, present, past medical, and family medical history is important when evaluating loss of consciousness in the very young. Concerning characteristics of syncope include lack of prodromal symptoms, no preceding postural changes or occurring in a supine position, after exertion or a loud noise. A family history of sudden unexplained death, ion channelopathy, cardiomyopathy, or congenital deafness merits further evaluation. Due to inherent challenges in diagnosis at this age, often there is a lower threshold for referral to a specialist.
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Affiliation(s)
- Juan Villafane
- Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital, Cincinnati, OH, USA. .,Department of Pediatrics, 743 East Broadway, Suite 300, Louisville, KY, 40202, USA.
| | - Jacob R Miller
- Department of Surgery, Division of Cardiothoracic Surgery, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Julie Glickstein
- Department of Pediatrics, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Jonathan N Johnson
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Jonathan Wagner
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Chris S Snyder
- Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western University, Cleveland, OH, USA
| | - Tatiana Filina
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott L Pomeroy
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Caitlin Haxel
- Department of Pediatrics, Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Pirooz Eghtesady
- Department of Surgery, Division of Cardiothoracic Surgery, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA
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Abdullah I. Commentary: Altruism reveals a surreptitious life-threatening myxoma. JTCVS Tech 2020; 3:238-239. [PMID: 34317887 PMCID: PMC8305311 DOI: 10.1016/j.xjtc.2020.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/08/2020] [Accepted: 07/14/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ibrahim Abdullah
- Department of Pediatric Cardiac Surgery, Cohen Children's Medical Center/Northwell Health, New Hyde Park, NY
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Singh V, Singh SK, Devenraj V, Kumar S. Giant right ventricular myxoma obstructing both inflow and outflow tract. Indian J Thorac Cardiovasc Surg 2019; 35:499-501. [PMID: 33061037 DOI: 10.1007/s12055-019-00793-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/06/2019] [Accepted: 01/11/2019] [Indexed: 11/30/2022] Open
Abstract
Myxomas are the most common benign cardiac tumors. We present a case of a 24-year-old male patient with a large right ventricular myxoma obstructing both inflow and outflow tract. He presented with worsening dyspnea and signs of right heart failure. The diagnosis of the right ventricular myxoma was made on echocardiography and multi-slide computed tomography. To prevent embolism and sudden death, emergency surgical excision was done successfully.
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Affiliation(s)
- Vikas Singh
- Department of Cardiovascular and Thoracic Surgery, King George's Medical University, Lucknow, Uttar Pradesh India
| | - Sushil Kumar Singh
- Department of Cardiovascular and Thoracic Surgery, King George's Medical University, Lucknow, Uttar Pradesh India
| | - Vijayant Devenraj
- Department of Cardiovascular and Thoracic Surgery, King George's Medical University, Lucknow, Uttar Pradesh India
| | - Sarvesh Kumar
- Department of Cardiovascular and Thoracic Surgery, King George's Medical University, Lucknow, Uttar Pradesh India
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Assaf Y, Nasser M, Jneid H, Ott D. Pulmonary Embolism Following Incomplete Surgical Resection of a Right Ventricular Myxoma: A Case Report and Review of the Literature. Cardiol Ther 2018; 7:107-117. [PMID: 29667131 PMCID: PMC5986674 DOI: 10.1007/s40119-018-0109-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Indexed: 12/28/2022] Open
Abstract
Abstract Right ventricular (RV) myxomas are extremely rare, but may have dreadful clinical sequelae including pulmonary embolism (PE). We present a case of a patient who had an RV myxoma that was attached to the tricuspid valve, and therefore could not be resected completely during surgery, and remnants of the tumor were seen on transthoracic echocardiogram during post-operative follow-up. Five months after surgery, the patient had PE, which could be due to tumor emboli or thromboemboli. Since repeat surgical resection was not feasible, the patient was started on warfarin. The patient is doing well and has had no PE recurrence over the past 20 months of follow-up. We have complemented the current case report with a comprehensive literature search and review on RV myxomas associated with PE in order to shed light on this uncommon but potentially lethal disorder. We concluded that right-sided cardiac myxomas, including RV myxomas, should be considered while dealing with PE, particularly in young patients with no risk factors, and that follow-up with echocardiography after surgery is important due to the possibility of recurrence, especially if complete resection was difficult to perform. Plain Language Summary Plain language summary available for this article.
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Affiliation(s)
- Yazan Assaf
- Faculty of Medicine, Damascus University, Damascus, Syria.
| | - Maher Nasser
- Baylor College of Medicine, Houston, TX, USA.,Baylor St. Luke's Medical Center, Houston, TX, USA.,Texas Heart Institute, Houston, TX, USA.,Houston Methodist Hospital, Houston, TX, USA
| | - Hani Jneid
- Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - David Ott
- Baylor College of Medicine, Houston, TX, USA.,Texas Heart Institute, Houston, TX, USA.,University of Texas Health Science Center at Houston, Houston, TX, USA
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Knight TE, Shiramizu B, Ly P, Thompson KS, Reddy V. Paroxysmal Nocturnal Dyspnea Secondary to Right Ventricular Myxoma: A Novel Presentation of an Unusual Tumor. Case Rep Pediatr 2018; 2018:4791379. [PMID: 29682382 DOI: 10.1155/2018/4791379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/04/2018] [Indexed: 11/18/2022] Open
Abstract
A 14-month-old male presented with paroxysmal nocturnal dyspnea and grade III/VI systolic ejection murmur at the upper left sternal border with an S4 gallop and was subsequently found to have a right ventricular cardiac myxoma. Prior presentations of these tumors have been with exertional syncope and murmur, asymptomatic murmur, or exertional dyspnea; the presentation of such a tumor with paroxysmal nocturnal dyspnea is novel.
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Escolar JM, Martínez A, González-juanatey JR, Durán D, Al-hamwy Z, Fernández AL. Mixoma del tracto de salida del ventrículo derecho. Cirugía Cardiovascular 2018; 25:41-44. [DOI: 10.1016/j.circv.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ghasemi R, Ghanei-Motlagh F, Nazari S, Yaghubi M. Huge mass in right side of the heart: A rare case report. ARYA Atheroscler 2016; 12:291-294. [PMID: 28607569 PMCID: PMC5455328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND The presence of primary intracardiac tumors are scarce, and most of them are myxomas. We reported, in this paper, a case with huge mass in the right side of the heart. CASE REPORT A 45-year-old man, with a complaint of bilateral lower limbs edema and exertional dyspnea, was admitted to intensive cardiac care unit. Cardiac auscultation revealed soft grade systolic murmur without any evidence of "tumor plop." Echocardiography showed a huge mobile mass in right side of the heart that suggested myxoma. Our patient underwent cardiac surgery with excision of 13 cm mass. Histopathological study was confirmed the diagnosis of mass type. CONCLUSION In this case report, it shows that in the differential diagnosis of right-sided heart failure, the right sided myxoma must be considered. The preferable approach in patient with cardiac myxomas is surgical excision to alleviate symptoms, early identification, and removal.
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Affiliation(s)
- Reza Ghasemi
- Assistant Professor, Department of Cardiology, Dey 9th Hospital, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Fahimeh Ghanei-Motlagh
- Department of Obstetrics and Gynecology, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Susan Nazari
- Department of Obstetrics and Gynecology, Dey 9th Hospital, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Mohsen Yaghubi
- Department of Cardiac Anesthesiology, School of Medicine, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran,Correspondence to: Mohsen Yaghubi,
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