SESSION TITLE: Cardiothoracic Surgery Cases - Student/Resident
SESSION TYPE: Student/Resident Case Report Slide
PRESENTED ON: Sunday, October 25, 2015 at 03:15 PM - 04:15 PM
INTRODUCTION: Cavernous hemangiomas are extremely rare benign tumor of the heart. Mainstay of treatment is complete surgical resection of the tumor. We report a case of atrial septal cardiac hemangioma, which was enucleated with complete preservation of endocardial wall.
CASE PRESENTATION: A 79 year old female presented to the cardiologist with a complaint of progressive dyspnea. TEE showed an intact interatrial septum with approximately 5 x 4 cm round soft tissue mass in posterior inferior part of interatrial septum, bulging into right atrium and slightly into the left atrium. (Figure 1) In the operating room, after an anterior atriotomy, a large mass protruded from the lower portion of the atrial septum. The mass was located between the orifices of the coronary sinus and the IVC subsequently pushing the coronary sinus medially. The tumor was carefully dissected with the preservation of the endocardium on both sides. Then, enucleation of the soft, jelly like tumor from within the septum was performed. The histopathologic study of the tumor showed a red-brown mass with soft and spongy consistency. (Figure 2) The mass was identified as a cavernous hemangioma. Patient remains asymptomatic and shows no signs of tumor recurrence on repeat echocardiogram on 2 year follow up.
DISCUSSION: Cavernous hemangioma is often an incidental finding in an asymptomatic patient but it may present as dyspnea, syncope, arrhythmias, congestive heart failure, or right ventricular outflow tract occlusion depending on the location of the tumor.  Progressive dyspnea was the only presenting symptom for our patient, which happens to be the most frequent clinical presentation in patients with cardiac hemangioma (43%).  Total surgical resection of the mass is considered the best way to treat cardiac tumors; however in the past, partial excision of masses has been performed. In a review of 23 cases, 12 patients did not undergo total resection. Outcomes were favorable without complete resection (data unavailable in 5 patients, 6 were alive and well, and 1 patient died postoperative day 1). Spontaneous regression wihtout intervention and recurrent hemangioma with total resection has been reported. [2,3]
CONCLUSIONS: Enucleation was performed without any recurrence or complications. Enucleation rather than resection of a benign cardiac tumor may be considered in selected patients since it may result in less morbidity, such as residual intracardiac defects or conduction abnormalities. To the best of our knowledge, this is the first report of this surgical technique for a cavernous hemangioma.
Reference #1: Brizard C, Latremouille C, Jebara VA, et al. Cardiac hemangiomas. Ann Thorac Surg. 1993 Aug;56(2):390-4. Review.
Reference #2: Palmer TE, Tresch DD, Bonchek LI. Spontaneous resolution of a large, cavernous hemangioma of the heart. Am J Cardiol. 1986 Jul 1;58(1):184-5.
Reference #3: Colli A, Budillon AM, DeCicco G, et al. Recurrence of a right ventricular hemangioma. J Thorac Cardiovasc Surg. 2003 Sep 126(3):881-3.
DISCLOSURE: The following authors have nothing to disclose: Shintaro Chiba, Fatima Janjua, Sathappan Kumar, Eugene Shteerman, Mikhail Vaynblat
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