Intraoperative voltage mapping-assisted resection of a giant right ventricular giant tumor: a case report

BACKGROUND: Cardiac hemangiomas located in the right heart can lead to serious complications, including right ventricular outflow tract (RVOT) obstruction, arrhythmias, and sudden cardiac death. Although surgical resection remains the primary treatment, complete excision of intramural tumors poses risk of impairing cardiac function. This case report describes the successful resection of a large right ventricular hemangioma using intraoperative voltage mapping, which enable maximal tumor removal while preserving myocardial integrity and preventing postoperative heart failure. CASE PRESENTATION: A 76-year-old female underwent a routine health examination in July 2024, during which cardiomegaly and nonspecific ST-segment changes were detected on electrocardiography. Contrast enhanced computed tomography revealed a well-defined 60 mm mass within the right ventricle, causing significant ROVT stenosis. No evidence of distant metastasis or elevated tumor markers was detected. The patient underwent tumor resection via median sternotomy. Intraoperative voltage mapping was utilized to delineate viable myocardium at the tumor margins. The tumor was excised while preserving functional myocardial tissue. Cryoablation was performed at the resection margins, and resultant defect in the right ventricular wall was reconstructed using a bovine pericardial patch. Histopathological analysis confirmed the diagnosis of cardiac hemangioma. The patient experienced an uneventful postoperative course had no postoperative complications and was discharged on postoperative day 16. Preoperative and postoperative cardiac magnetic resonance imaging demonstrated preserved right ventricular function. CONCLUSIONS: Intraoperative voltage mapping proved to be a valuable adjunct in the surgical management of right ventricular tumors, enabling effective tumor resection while preserving myocardial tissue and maintaining postoperative cardiac function.