[Resection under Endoscopic Guidance of Papillary Fibroelastoma in the Left Ventricular Outflow Tract:Report of a
Kohei Shibahashi1, Atsushi Itoh, Yoshiko Shintani
1Department of Cardiovascular Surgery, Yokohama Sakae Kyosai Hospital, Yokohama,Japan.
Insights
This study highlights the successful endoscopic resection of a cardiac papillary fibroelastoma in the left ventricular outflow tract. Endoscopic surgery proved effective for difficult-to-access cardiac tumors, preventing recurrence.
Area of Science:
- Cardiology
- Surgical Oncology
- Medical Devices
Background:
- Cardiac tumors are rare, with papillary fibroelastomas being the most common primary cardiac tumors.
- Left ventricular outflow tract masses can pose diagnostic and therapeutic challenges due to their location.
Observation:
- A 76-year-old male presented with a suspected cardiac tumor.
- Transesophageal echocardiography revealed a mobile mass in the left ventricular outflow tract.
- The patient also had paroxysmal atrial fibrillation.
Findings:
- Endoscopic resection of the cardiac papillary fibroelastoma was successfully performed due to difficult direct visualization.
- Pathological diagnosis confirmed cardiac papillary fibroelastoma.
- Postoperative assessment showed no residual tumor or aortic regurgitation, with no recurrence at 20 months.
Implications:
- Endoscopic techniques offer a viable and effective surgical option for cardiac tumors in challenging locations.
- This approach may improve visualization and facilitate information sharing among surgical teams.
- Minimally invasive resection can lead to favorable long-term outcomes for cardiac papillary fibroelastoma.
Abstract:
A 76-year-old man was admitted to our hospital for a thorough examination of a suspected cardiac tumor on transthoracic echocardiography. Transesophageal echocardiography demonstrated a 9.4×8.1 mm mobile stalk-like mass in the left ventricular outflow tract. A preoperative electrocardiogram revealed paroxysmal atrial fibrillation. Tumor resection and pulmonary vein isolation were performed to prevent embolism and confirm the diagnosis. The tumor was resected using an endoscope because it was difficult to evaluate the tumor under direct view from the aortic valve. Pathological diagnosis was cardiac papillary fibroelastoma. Postoperative echocardiography showed no residual tumor or aortic regurgitation. One year and eight months passed since the surgery, and no recurrence of the tumor was detected. In cases like this one, where direct observation of the tumor is difficult, we suggest that the use of an endoscope may be effective because it has the advantage of sharing information with other surgeons.
