CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 1, January – April 2024 64 AFRICA Case Report Calcified right ventricular fibroma in an adult Huanhuan Gao, Shuai Yuan, Zhiqiang Hu, Zhelan Zheng, Yanli Wang, Shengjun Wu Abstract Background: Cardiac fibromas are benign tumours of the heart and are composed of fibroblasts and collagen. They are one of the most common cardiac tumours encountered in children and adolescents but are rare in adults. Case report: The patient was a 57-year-old man who presented, complaining of a two-year history of chest tightness at rest. Transthoracic echocardiography revealed a severely calcified mass protruding from the anterior wall of the right ventricle near the apex. The patient was referred for tumour resection. Postoperative histopathological examination identified the calcified mass to be a cardiac fibroma. The patient’s postoperative recovery was unremarkable and he was discharged eight days after surgery. During follow up, he has been free from any troublesome symptoms. Conclusions: Pre-operative diagnosis using various imaging modalities and early surgery are key to optimising the prognosis of patients with a cardiac fibroma. Keywords: cardiac fibroma, tumours, transthoracic echocardiography, calcified mass Submitted 7/6/21, accepted 13/2/23 Published online 3/323 Cardiovasc J Afr 2024; 35: 64–66 www.cvja.co.za DOI: 10.5830/CVJA-2023-007 Cardiac fibroma is a rare benign tumour in the myocardium and is composed of fibroblasts and collagen. It is the second most common benign cardiac tumour after rhabdomyoma in children but is rarely seen in adults.1,2 Cardiac fibroma is usually located in a ventricle or the interventricular septum and typically presents as central calcification, which distinguishes it from a rhabdomyoma.3 The clinical manifestations of cardiac fibroma are non-specific but include stethalgia, arrhythmia, dyspnoea and even sudden death, depending on its position and size.4 However, cardiac fibroma may be symptomless and an incidental finding on imaging.3 Early surgery is key to a favourable outcome in a symptomatic patient.5,6 The study was approved by the Institutional Review Board at The First Affiliated Hospital of Zhejiang University, Hangzhou, China. The procedures were conducted according to the principles of the Helsinki Declaration. Case report The patient was a 57-year-old man who presented with a two-year history of chest tightness and nausea and was hospitalised in The First Affiliated Hospital of Zhejiang University, Hangzhou, China, in December 2020. The patient was in a good overall condition and denied palpitations, syncope, chest pain and dyspnoea. His blood pressure, heart rate, electrocardiogram and laboratory investigations were within the normal range. However, calcification of the right cardiac border was found incidentally on a chest radiograph. Transthoracic echocardiography revealed a 4.3 × 0.7-cm area of calcification within the myocardium at the anterior wall of the right ventricle near the apex, but normal right ventricular wall motion (Fig. 1A). The diagnosis of a benign pericardial tumour was confirmed by computed tomography (Fig. 1B), and coronary angiography showed normal coronary arteries (Fig. 1C). Intraoperative transoesophageal echocardiography identified a 3 × 2-cm hyperechoic mass in the apical interventricular groove, stretching to the anterior wall of the right ventricle (Fig. 1D). Basedon thediagnosis, the tumourwas scheduled tobe resected via standard median sternotomy without cardiopulmonary bypass. Cardiopulmonary bypass is required if invasion into the ventricular wall or the coronary artery is suspected intraoperatively or in the event of any intra-operative haemodynamic deterioration. At surgery a protruding firm, yellowish mass (3 × 3 × 2 cm) was discovered close to the left anterior descending artery (Fig. 2A). Given that the tumour was growing on the surface of the right ventricular apex and not protruding into the cavity of the right ventricle, the border between the tumour and the superficial fatty layer of the myocardium was sharply dissected after local fixation of the tumour, with preservation of the left anterior descending artery. The tumour was carefully and completely resected with off-pump surgery without damaging the left anterior descending artery (Fig. 2B). Echocardiography and Vascular Ultrasound Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China Huanhuan Gao, MD Shuai Yuan, MD Zhiqiang Hu, MD Zhelan Zheng, MD Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China Yanli Wang, MD Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China Shengjun Wu, MD, wsjsw@zju.edu.cn
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