Troubleshooting a missing intra-cardiac tumor at the time of bypass

Primary cardiac tumors are rare and the only curative treatment consists of complete excision under cardiopulmonary bypass (CPB). This case report presents an unusual case of an intra-cardiac tumor which was missing at the time of surgical excision.

The patient was scheduled to undergo surgical tumor removal and double coronary artery bypass grafting (CABG). Intraoperatively, transesophageal echocardiography (TEE) demonstrated a mobile and pediculated tumor in the left ventricular outflow tract (LVOT). Unfortunately, at the time of tumor excision under CPB, this was missing. Before confirming tumor embolization, the CPB system was inspected. The tumor was found on the lateral part of the defoaming filter.

Careful mobilization of the heart is recommended during surgery. In this case, it was unexpected that the tumor made its way through the vent line and unidirectional valve up to the venous reservoir where it was fortunately found.