Successful surgical treatment for recurrent cardiac fibroma 21 years after resection
© Kusajima et al.; licensee Springer. 2015
Received: 24 March 2015
Accepted: 5 May 2015
Published: 16 May 2015
Cardiac fibromas are rare benign tumors usually seen in the pediatric population. Generally, long-term survival after surgical resection is favorable, and recurrence of fibroma has been hardly reported. Herein, we report a case of a 34-year-old woman who presented with ventricular tachycardia 21 years after resection of a cardiac fibroma and was found to have a recurrent giant cardiac fibroma. We performed a complete resection of the recurrent fibroma. At the 2-year follow-up, she remains asymptomatic with no evidence of ventricular tachycardia or recurrence of fibroma.
Cardiac fibromas are rare benign tumors predominantly seen in the pediatric population . Patients can be asymptomatic or present with palpitations, cardiac murmur, syncope, arrhythmias, symptoms of congestive heart failure, or sudden death. The clinical presentation depends on tumor location and size [2–5].
Because cardiac fibromas rarely regress spontaneously , surgical resection should be considered in symptomatic cases. If possible, complete resection is usually recommended; otherwise, partial resection, heart transplantation, or conservative management is also advocated . Generally, long-term survival after surgical resection is favorable and recurrence has been scarcely reported [3, 5, 6]. In this report, we describe a case of successful resection of a recurrent giant fibroma. To the best of our knowledge, this is the first report of successful surgical treatment of a recurrent cardiac fibroma.
A 34-year-old woman complained of palpitations and consulted a doctor. She had a history of resection of a right ventricular (RV) fibroma 21 years ago at another hospital. At the initial operation, complete resection was impossible because of its difficulty. Five years after the operation, follow-up was ceased because she did not have any cardiac symptoms.
Cardiac fibromas are rare but benign tumors and more than 80% of them occur in the pediatric population [2, 7]. Long-term results after surgical resection were generally reported to be favorable [1, 3]. Therefore, medical follow-up is often ceased once the patient becomes an adult. There has never been a report of a recurrent case after surgical resection to date . In the present case, complete resection was not performed at the initial operation because of diffuse involvement of the fibroma into the right ventricular trabeculae. At this time of operation, the tumor appeared to originate from the right ventricular septum, involving the apex and the posterior wall of LV. Therefore, we believed that this tumor is a recurrent fibroma proliferating from the residual lesion.
The majority of fibromas are found in the LV or RV wall, and fewer than 20% are detected in the IVS . Fibromas can cause lethal arrhythmia, valve regurgitation, and ventricular inflow/outflow tract obstruction depending on their location and size [4, 8]. If left untreated, fibromas can increase the risk of fatality. Therefore, surgical resection is recommended, especially in symptomatic cases. Basically complete resection is recommended first. But, partial resection can be an acceptable option when papillary muscle, valvular, and/or ventricular function might be reduced after complete resection [3, 7].
In conclusion, we report the first case of a successful complete resection of a recurrent cardiac fibroma 21 years after the initial operation. Recurrence should be considered when new-onset arrhythmia or cardiac murmur is noted in a patient with a history of fibroma resection, especially without complete resection. Although partial resection may be acceptable to preserve valvular and/or ventricular function, complete resection is preferable to eliminate the risk of recurrence.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
- Padalino MA, Vida VL, Boccuzzo G, Tonello M, Sarris GE, Berggren H, et al. Surgery for primary cardiac tumors in children: early and late results in a multicenter European Congenital Heart Surgeons Association study. Circulation. 2012;126:22–30.View ArticlePubMedGoogle Scholar
- Parmley LF, Salley RK, Williams JP, Head 3rd GB. The clinical spectrum of cardiac fibroma with diagnostic and surgical considerations: noninvasive imaging enhances management. Ann Thorac Surg. 1988;45:455–65.View ArticlePubMedGoogle Scholar
- Cho JM, Danielson GK, Puga FJ, Dearani JA, McGregor CG, Tazelaar HD, et al. Surgical resection of ventricular cardiac fibromas: early and late results. Ann Thorac Surg. 2003;76:1929–34.View ArticlePubMedGoogle Scholar
- Chen Y, Sun J, Chen W, Peng Y, An Q. Third-degree atrioventricular block in an adult with a giant cardiac fibroma. Circulation. 2013;127:e522–4.View ArticlePubMedGoogle Scholar
- Torimitsu S, Nemoto T, Wakayama M, Okubo Y, Yokose T, Kitahara K, et al. Literature survey on epidemiology and pathology of cardiac fibroma. Eur J Med Res. 2012;17:5.View ArticlePubMed CentralPubMedGoogle Scholar
- Nwachukwu H, Li A, Nair V, Nguyen E, David TE, Butany J. Cardiac fibroma in adults. Cardiovasc Pathol. 2011;20:e146–52.View ArticlePubMedGoogle Scholar
- Henaine R, Adam E, Azarnoush K, Yashimura N, Cannesson M, Millon A, et al. Is subtotal resection of a right ventricular fibroma a valid surgical option? J Thorac Cardiovasc Surg. 2009;137:e32–4.View ArticlePubMedGoogle Scholar
- Grinda JM, Macé L, Dervanian P, Neveux JY. Obstructive right ventricular cardiac fibroma in an adult. Eur J Cardiothorac Surg. 1998;13:319–21.View ArticlePubMedGoogle Scholar
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.