Discussion:
Primary cardiac tumours in childhood have a very low incidence, although in recent years, the incidence has increased because of improvements in heart imaging techniques[3] [4]. Most primary cardiac tumours are benign in the sense they are not invasive. However, benign tumours maintain the potential for serious illness related to significant haemodynamic compromise or life-threatening dysrhythmias. In most cases, the first clinical manifestation depends on the tumour location and size. In our case, the mass was not very large in size, and the patient was symptomatic with the persistence of a heart murmur.
Due to the association of lipoblastoma with other heart malformations, preoperative diagnosis remains challenging. Transthoracic echocardiography has high sensitivity for the detection of cardiac masses. It can often provide precise information about the tumour size, location, shape, mobility, and associated features. It is usually the first-line investigation. Cardiac MRI is especially advantageous in defining tissue characteristics and, through the use of gadolinium-based contrast agents, in differentiating between cardiac masses such as tumours, which display variable enhancement, and thrombi, which do not enhance at all[5]. Before the operation, this patient was considered to be diagnosed with congenital valvular stenosis and ASD, therefore, no MRI was applied. The diagnosis of lipoblastoma is often made postoperatively. It demonstrated adipocytes in different stages of maturation without anaplasia. The main histological features of the tumour were multinodular and myxoid foci. Chromosomal abnormalities have been reported in lipomatous tumours. In our case, we did not perform any genetic study because the histopathological evaluation alone was definitive.
Tumours on the heart valve are more likely to cause haemodynamic disturbances. Complete resection yields an excellent prognosis[4,6]. Occasionally, the resection of adjacent structures is necessary to achieve complete extirpation; however, in our patient, the resection of the adherent pulmonary valve was not required. The resection of the tumour and its adjacent tissue may damage the heart structure; therefore, it is important to carefully evaluate preoperative parameters.
Conflicts of interest: On behalf of all authors, the corresponding author states that there is no conflict of interest.
Funding: The study did not receive funding.
Ethical Standards:The study was approved by Beijing children’s Hospital Clinical New Technology and Research Ethics Committee.