Left Ventricular Fibroma Excision

A 30-year-old old woman presented with palpitations and recurrent syncope for the past month. Her 2D echocardiogram showed a large intramyocardial mass arising from the lateral wall of the left ventricular (LV). Chest X ray showed bulge in the left heart border. MRI heart revealed a circumferential mass lesion arising from the posterolateral wall of the LV, suggestive of fibroma. The patient was taken up for surgery. Median sternotomy was done. On inspection, the authors could see a bulge in the high lateral wall of the LV. Obtuse marginal artery was seen arising away from the bulge. Aortic and bicaval cannulation was done. Cardiopulmonary bypass was established. Under cardioplegic arrest, the epicardium over the mass was incised and the incision was well away from the A-V groove. The mass was separated from the myocardium using sharp and blunt dissection. The mass had no myocardial infiltration. Through traction and counter-traction, the plane between the mass and myocardium was delineated by sharp dissection using 15 knife. Utmost care was taken to avoid entering the LV cavity and distortion of papillary muscles. The mass removed was approximately half the size of the heart.

After that, the authors filled the heart by clamping the venous line, so that they could see the bleeding from the LV cavity, and it was closed using 5-0 prolene sutures. Leak from LV cavity can produce disastrous complications, hence it was meticulously sealed. Cross clamp was released. An apex stabilizer was used to position the heart. The tumor cavity was closed using 4-0 pledgeted prolene sutures. The authors decided to suture it to a beating heart, so that they could visualize the bleeding from the cavity. Though technically difficult, the thick fibrotic tissue was good enough to hold the sutures. The suture line was reinforced with a second layer of continuous polene sutures. The patient was weaned off CPB. The patient had an uneventful postoperative recovery and she was discharged on postoperative day six. She has been on follow-up for the past 11 years. Her recent echocardiogram taken after 11 years showed no recurrence of fibroma and had normal LV function.

References

1. Zheng X, Song B.Left ventricle primary cardiac fibroma in an adult: A case report. Oncol Lett. 2018 Oct;16(4):5463-5465.
2. Gasparovic H, Coric V, Milicic D, Rajsman G, Burcar I, Stern-Padovan R, et al. Left ventricular fibroma mimicking an acute coronary syndrome. Ann Thorac Surg. 2006 Nov;82(5):1891-1892.

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