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Asian Cardiovasc Thorac Ann 2002;10:64-65
© 2002 Asia Publishing EXchange Pte Ltd

CASE STUDY

Lipoma of the Left Ventricle

Srinivas Babu Kosuru, MCh, Gopalakrishnan Mundayat, MCh, Mahadevan Ramachandran, MCh, Velivela Satyaprasad, MS

Department of Cardiovascular and Thoracic Surgery Amrita Institute of Medical Sciences and Research Centre Cochin, Kerala, India
Velivela Satyaprasad, MS Tel: 91 484 33 9080 Ext. 1125 Fax: 91 484 34 0801 email: satyaprasadv{at}aimshospital.org Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Lane, Elamakkara, Cochin, Kerala 682026, India.

   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 CASE REPORT
 DISCUSSION
 REFERENCES
 
A 36-year-old female was admitted with dyspnea on exertion of one year's duration. Echocardiography revealed a tumor arising from interventricular septum with dynamic left ventricular outflow tract obstruction. On cardiopulmonary bypass with cardioplegic arrest, the tumor was approached through a transverse aortotomy, and excised from the interventricular septum through the aortic valve. Postoperative recovery was uneventful and the patient was asymptomatic with no recurrence at follow-up after one year.


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
CASE REPORT
 DISCUSSION
 REFERENCES
 
Primary cardiac tumors of the ventricles are very uncommon.1 Most reported cardiac lipomas have been diagnosed incidentally at autopsy.2 A lipoma in the ventricular septum is extremely rare; a review of the literature indicated that only 6 cases of lipoma in the ventricular septum were reported up to 1998.3


   CASE REPORT
TOP
 ABSTRACT
 INTRODUCTION
 CASE REPORT
DISCUSSION
 REFERENCES
 
A 36-year-old female presented in New York Heart Association functional class III with breathlessness of one year's duration. There was no history of syncope, transient ischemic attacks, thromboembolism, chest pain, or rheumatic fever. On clinical examination, an ejection systolic murmur was detected at the apex and left parasternal border, conducting to the carotid arteries. An electrocardiogram showed normal sinus rhythm, left atrial enlargement, and left ventricular hypertrophy with ST-T changes. Chest radiography revealed a cardiothoracic ratio of 50% with normal bronchovascular markings. Echocardiography demonstrated a sessile echogenic mass of 2.7 x 2.6 cm in size, attached to interventricular septum, and a dynamic left ventricular outflow tract gradient of 61 mm Hg. Transesophageal echocardiography showed a sessile mass attached to the anterior part of the interventricular septum, and devoid of any attachment to the mitral valve (Figure 1Go); the other cardiac valves were normal with good left ventricular function. Excision of the tumor was performed via a median sternotomy. Cardio-pulmonary bypass was established by aortic and two-stage single venous cannulation. The patient was cooled to 32°C. An aortic crossclamp was applied, and antegrade cold crystalloid cardioplegic arrest was achieved. The lesion was approached through a transverse aortotomy to expose the tumor through the aortic valve. An ovoid, sessile, firm yellowish tumor with a lobulated surface, approximately 2.5 x 3 x 3 cm, was found arising from the anterior part of the interventricular septum just beneath the aortic valve. It was excised en bloc from the inter-ventricular septum. Intraoperative transesophageal echo showed no significant gradient across the left ventricular outflow tract, and no evidence of residual tumor. The postoperative course was uneventful and the patient was discharged on the 7th postoperative day. Histopathological examination showed a firm yellowish lobulated mass which, on microscopic examination, revealed lipomatous hypertrophy (Figure 2Go). The patient was asymptomatic at follow-up after 1 year; echocardiography demonstrated no significant gradient across the left ventricular outflow tract, and no recurrence of the tumor.




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  		Figure 1. Transesophageal echocardiograms. (A) Four-chamber view showing the tumor in the left ventricle attached to the interventricular septum. (B) Transgastric short axis view showing the tumor attached to interventricular septum and free of the mitral valve. IVS = inter-ventricular septum, LA = left atrium, LV = left ventricle, MV = mitral valve, RA = right atrium, RV = right ventricle.

 


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  		Figure 2. Photomicrograph showing lobules of mature fat cells, hypertrophic myocytes, thickened blood vessels, and fibrous tissue with no evidence of malignancy (hematoxylin and eosin stain, original magnification x40).

 

   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 CASE REPORT
 DISCUSSION
REFERENCES
 
Intraventricular lipoma was first described and success-fully removed by Bradford and colleagues in 1980.4 The natural history of cardiac lipomas is not well known as most have been diagnosed incidentally at autopsy.2 When discovered antemortem, this tumor usually presents as a sessile subendocardial growth that bulges into a cardiac chamber and may cause obstructive symptoms. Less frequently, an intramyocardial lipoma may produce arrhythmias and conduction disturbances.5 Lipomas are usually solitary, but multiple lipomas are known to occur in patients with tuberous sclerosis. This patient did not have any additional lipomas.

Cardiac lipomas tend to occur in younger age groups.6 We believe that a symptomatic solitary cardiac lipoma should be excised, and good long-term results can be anticipated. Our patient is under regular surveillance for any possible recurrence.


   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 CASE REPORT
 DISCUSSION
 REFERENCES
 

  1. Dietl CA, Torres AR, Favaloro RG. Ventricular tumors: surgical options. Cardiovasc Surg 1993;1:632–7.[Medline]

  2. Harjola PT, Ala Kulju K, Ketonen P. Epicardial lipoma. Scand J Thorac Cardiovasc Surg 1985;19:181–3.[Medline]

  3. Kato Y, Murata H, Kitai K, Yasuoaka T, Mukai S. A case of cardiac lipoma in the ventricular septum [Japanese]. Jpn J Thorac Cardiovasc Surg 1998;46:1057–60.[Medline]

  4. Bradford JH, Nomier AM, Watts LE. Left ventricular lipoma: echocardiographic and angiographic features. South Med J 1980;73:663–5.[Medline]

  5. Reyes LH, Rubio PA, Korompai FL, Guinn GA. Lipoma of the heart. Int Surg 1976;61:179–80.[Medline]

  6. Reyes CV, Jablokow VR. Lipomatous hypertrophy of the atrial septum: a report of 38 cases and review of the literature. Am J Clin Pathol 1979;72:785–8.[Medline]





This Article
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