From the Department of Cardiovascular Surgery (M.T., S.Y.) and the
Department of Internal Medicine (T.S.), Fukui Prefectural Hospital, Japan.
Correspondence to Masao Takahashi, MD, Chigasaki Tokushukai Hospital, Department of Thoracic and Cardiovascular Surgery, 14-1, Saiwai-cho, Chigasaki, Kanagawa, 253-0052, Japan.
An
asymptomatic 58-year-old woman was admitted because of a
left ventricular tumor detected on the echocardiogram. The
tumor was in contact with a pedicle arising from the
ventricular septum. Pulmonary arteriography showed
that the oval tumor mass moved freely during the cardiac cycle.
Three-dimensional CT was useful to uncover the entire image of the
tumor (Figure 1
© 1998 American Heart Association, Inc.
Images in Cardiovascular Medicine
Endoscopic Resection of Malignant Fibrous Histiocytoma in Left Ventricle
). Selective
coronary angiography revealed 2 arteries feeding into the tumor
from septal branches (Figure 2). The risk
of systemic thromboembolism or sudden death due to tumor embolism was
an indication for surgery. Under total cardiopulmonary bypass,
transaortic resection of the tumor was performed without
ventriculotomy. A 30° endoscope measuring 5.3 mm in diameter was
inserted via the aortotomy. The left ventricular chamber
was almost entirely occupied by the tumor (Figure 3, top). The tumor was not in contact
with mitral valve leaflets, chordae tendineae, papillary muscles, or
left ventricular endocardium. When the tumor was drawn down
to the free wall by forceps, a pedicle of the tumor was clearly seen to
be arising from the midportion of the ventricular septum
close to the posterior papillary muscle. The pedicle was carefully
resected with endoscopic scissors (Figure 3, bottom). The tumor was
yellow-gray, measured 30x28x25 mm, and weighed 8.0 g.
Endoscopic observation was again performed to ascertain the absence of
residual tumor. Operation time, cardiopulmonary bypass time,
and aortic clamping time were 180, 70, and 42 minutes, respectively.
Mechanical respiratory support was removed 6 hours after the surgery,
and no blood