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.
When she was referred to our center, electrocardiography showed sustained ventricular tachycardia (VT) (Fig. 1), which was well suppressed with oral amiodarone. Transthoracic echocardiography showed a giant mass (80 × 80 × 60 mm) located in the intraventricular septum (IVS) (Fig. 2) and the posterior wall of the left ventricle (LV). General ventricular wall motion was good (LV ejection fraction of 60%). Tricuspid regurgitation (TR) and mitral regurgitation (MR) were trivial. Enhanced cardiac computed tomography scan revealed that the mass contained calcification and was poorly enhanced. Cardiac magnetic resonance imaging showed that the mass oppressed the LV cavity with low tumor signal on the T2-weighted image (Fig. 3). Positron emission tomography with fluorine-18 fluorodeoxyglucose showed no abnormal uptake within the tumor. These findings strongly suggested the diagnosis of recurrent fibroma. The tumor was huge, oppressing the LV cavity, and was regarded to be the cause of VT. Therefore, we arranged surgical resection.
Complete surgical resection was performed through median sternotomy with cardiopulmonary bypass under cardioplegic arrest. The gray-white tumor appeared to originate from the IVS involving the apex and the LV posterior wall. The solitary tumor was completely excised by sharp dissection together with the feeding artery (Fig. 4). The defect of the IVS, sized 5 × 15 mm, was closed with Teflon felt-pledgeted 4–0 polypropylene mattress sutures. The giant remnant cavity and ventricle wall were closed with double layers of 4–0 polypropylene running sutures. Cardiopulmonary bypass time and aortic cross clamp time were 113 and 64 min, respectively. The patient was easily weaned from cardiopulmonary bypass, and intraoperative transesophageal echocardiography showed good ventricular contraction without TR, MR, or shunt flow through the IVS. The excised specimen showed a well-circumscribed solid firm mass without capsule and measured 80 × 80 × 60 mm, weighing 140 g. Most part of the tumor composed of hyalinized acellular fibrous tissue with focal calcification. Sporadic part showed fibroblast proliferation without malignancy. Pathologic examination confirmed the diagnosis of benign cardiac fibroma (Fig. 5) and total extirpation. Ventricular tachycardia was not observed on continuous electrocardiographic monitoring. Two years after the operation, the patient could cease amiodarone and remained asymptomatic without VT. Transthoracic echocardiography showed good ventricular contraction without residual shunt flow or recurrence of fibroma.