Huge right ventricle cardiac fibroma in a child patient
Qiang Fan*, Yunfei Ling*, Qi An#
Department of Cardiovascular surgery, West China Hospital, Sichuan
University
* These authors contributed equally to this work and should be
considered co-first authors
#Corresponding author: Qi An
Address: No. 37 GuoXue Xiang, Chengdu, Sichuan, 610041, People’s
Republic of China
Tel: + 86 28 85422897
Fax: + 86 28 85422897
Email: anqi@scu.edu.cn
Conflicts of Interest: None
Funding: None.
Word count: 280
Key words cardiac fibroms, right ventricle, surgical treatment
Abstract In this case report, we describe a rare large right
ventricular fibroma with sudden chest pain in a 9 year old child. The
tumor was successfully surgical removed under cardiopulmonary bypass,
but there was only a small remnant of the tumor to avoid rupture of the
right ventricle and injury to the tricuspid valve. Pathological
examination confirmed that the tumor was fibrous borderline tumor. The
patient’s heart function and the size of atrium and ventricles were
normal, and there was no tricuspid regurgitation at 3-months follow-up.
It was reported that the age less than 17 years old at time of diagnosis
are associated with a poor prognosis, the long term outcome for this
child patient needs further follow-up.
A previously healthy 9-years-old boy presented to our hospital with a
sudden chest pain for 2 weeks. There were no abnormities detected in
physical examination. And electrocardiogram and chest X-ray was normal.
Transthoracic echocardiography revealed a 45×75mm well-mass in the
lateral and anterior wall of right ventricle adjacent to right
atrioventricular groove and compressing right heart chamber (panel A,
arrow; Supplementary material online, Video 1). Cardiac magnetic
resonance (CMR) LGE imaging in short-axis view showed inhomogeneous
delayed enhancement (panel B, arrow) and CMR perfusion imaging in
four-chamber view showed very little blood perfusion (panel C, arrow) of
the mass. Volume-rendered image of the heart from different perspectives
showed exactly the position and surrounding structures of the mass
(Supplementary material online, Video 2). Considering the tumor size and
patient’s symptom, surgical resection through a median sternotomy under
cardiopulmonary bypass. The tumor has an intact adventitia extending
from the epicardium (Supplementary material online, Video 3). To avoid
the rupture of right ventricle and injury to tricuspid valve, the tumor
was removed nearly completely (panel D and E). The cavity left by
excision of the tumor was filled by in-situ suture of the residual
tissue. Intraoperative transoesophageal echocardiography showed there
was mild tricuspid regurgitation and good heart function. The pathologic
diagnosis was mesenchymal and fibrogenic tumor that prone to ligamentoid
fibromatosis (panel F). Immunohistochemistry is positive for smooth
muscle actin (panel G), whereas CD34, S100 are negative that confirmed
the fibrous origin of the tumor. The patient recovered well and
discharged unevenfully. The patient’s heart function and the size of
atrium and ventricles were normal, and there was no tricuspid
regurgitation at 3-months follow-up.
Consent The study were approved by the relevant ethics
committees, and oral informed consent was obtained for the participant.