Surgery was performed trough a cardiopulmonary bypass and aortic clamping.
It was performed a subepicardial lipoma resection,
leaving a myocardial defect and two holes in the LV,
which were repaired with sutures overlaying the myocardium.
A first time suture was performed using continuous sutures supported by Teflon patch (similar to aneurysmorrhaphy).
Fig. 8 The intraoperative transesophageal echocardiogram (TTE) shows mitral regurgitation (MR) grade III / IV by posteromedial papillary muscle traction.
It was decided to redo the repair of the defect making direct muscle approximation with a continuous suture,
avoiding distortion,
with good results echocardiographic (MR grade II).
It was found a intramyocardial mass on LV posterolateral wall measuring 5.5cm,
unencapsulated Fig. 9 .
The postoperative course passed without complications.
TTE at discharge: non dilated LV with preserved function.
Mild MR.
Normal wall thickness.
Fig. 8: Surgery shows an intramyocardial mass on the LV posterolateral wall measuring 5.5cm, non-encapsulated. It was performed a subepicardial lipoma resection, leaving a myocardial defect and two holes in the LV. It was sutured overlaying the myocardium.
References: Department of Cirugía Cardíaca. CHUVI, Vigo/España 2012
Fig. 9: Macroscopically there was lipoid unencapsulated 5.5 cm mass.
References: Department of Cirugía Cardíaca CHUVI, Vigo, España 2012
Cardiac lipomas are composed essentially of matureFig. 10 ,
but may be entrapped myocites at the base of the tumorFig. 11 .
Fig. 10: Microscopic pathologic findings are essentially of mature adipocytes.
References: Departement Anatomia Patológica CHUVI, VIgo/ España 2012
Fig. 11: Microscopic pathologic findings at the base of the tumor shows entrapped myocites between the mature adipocytes.
References: Department Anatomía Patológica H.Meixoeiro, Vigo/España 2012
The postsurgery MRI shows normal systolic and diastolic function of the LVFig. 12 Fig. 13 .
The LV ejection fraction improved mildlyFig. 14 .
Fig. 12: Preoperative cine-MRI 2 chambers view. It is like retraction in the papillary muscles, the base of the tumor.
Fig. 13: Postoperative cine- MRI 2 chambers view.
Fig. 14: The postoperative MRI shows a mild LV function improvement.
There isn´t segmental myocardial contractility abnormalitiesFig. 15 .
The MRI also shows a LV wall postsurgery sero-hematic collectionFig. 16 .
CT before and after IV contrast administration excluded communication between the collection and the LV cavity.
Fig. 15: Postoperative cine MRI short axis view shows a perfect contractibility.
Fig. 16: MRI 30 days postopertative shows a sero-hematic collection in the surgical bed.
Cardiac lipomas are rare tumors usually discovered incidentally and can originate from the subendocardium,
subpericardium or myocardium. Can appear in any cardiac chamber.
Multiplicity has been described usually in tuberosclerosis sclerosis.
Echocardiography can define the mass morphology. MRI and CT can delineate the extension of the tumor,
tissue cacharacterization and assessment of the coronary artery.
Coronary arteriography may be helpful by defining the coronary anatomy and delineating a possible arterial supply.
Radiologically and histologically,
lipomas must be differentiated from liposarcomas,
especially from well-differentiated types.