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Images and Case Reports in Interventional Cardiology
Endovascular Treatment of Right Ventricular Tumor
Nicholas Kipshidze, MD, PhD, FACC, FESC, FSCAI; Akaki Archvadze, MD;
Vakhtang Kipiani, MD, PhD; Zaza Katsitadze, MD, PhD;
Zviad Matoshvili, MD; Ulrich Sigwart, MD, FACC, EFESC, FRCP
P
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rimary cardiac tumors are rare, with the incidence between 0.17% and 0.19% in unselected autopsy series.1,2
After myxoma, cardiac fibroma is the second most common
type of benign primary cardiac tumor.1,3 Untreated, cardiac
fibroma has a poor prognosis, with death occurring in up to
25% of patients, usually the result of sudden death from
conduction disturbances.1,3 Surgical extirpation is considered
to be the treatment of choice but is associated with high
morbidity and mortality in the early (10%) and late (4%)
recovery periods.4
In the present report, we describe a novel endovascular
treatment for right ventricular (RV) fibrolipoma with successful outcome.
Figure 2. Biopsy material stained with hematoxylin and eosin
(on the left) and picrofuchsin by Van Gieson (on the right)
defined the tumor as fibrolipoma. Red outline indicates muscle;
yellow, connective tissue; and green, fat.
The ECG revealed SIQIII pattern, incomplete right bundlebranch block, and negative T waves in V1-V4. The transthoracic echocardiogram (TTE) showed normal left ventricular
ejection fraction (56%), elevated systolic pulmonary artery
pressure (55 mm Hg), and an elongated 40⫻90 mm mass in
the free wall of the RV.
Computed tomography (CT) confirmed the presence of a
vascularized 39⫻85 mm intramural mass that obstructed the
RV outflow tract (Figure 1). CT-guided percutaneous biopsy
was performed. Histopathology confirmed the tumor as
fibrolipoma (Figure 2). Coronary angiography showed a
normal left coronary artery and a large area of hypervascularized myocardium near the RV projection that was supplied
by the acute marginal branches of the right coronary artery
(Figure 3).
Case Report
A 38-year-old Caucasian male patient presented to our
hospital with complaints of atypical chest pain. For several
months, he had been having gradually worsening shortness of
breath on exertion and generalized weakness and fatigue.
Figure 3. Angiography of the right coronary artery (RCA): A
large hypervascularized zone is supplied by acute marginal
branches of the RCA.
Figure 1. Contrast-enhanced computed tomography revealed
elongated mass in the free wall of the right ventricle.
Received October 5, 2010; accepted August 5, 2011.
From the N. Kipshidze Central University Hospital, Tbilisi, Georgia (N.K., A.A., V.K., Z.K., Z.M.); Lenox Hill Heart and Vascular Institute, New
York, NY (N.K.); and Université de Genève, Geneva, Switzerland (U.S.).
Correspondence to Nicholas Kipshidze, MD, PhD, FACC, FESC, FSCAI, Lenox Hill Heart and Vascular Institute, 130 E 77th St, New York, NY
10021. E-mail [email protected]
(Circ Cardiovasc Interv. 2011;4:e33-e35.)
© 2011 American Heart Association, Inc.
Circ Cardiovasc Interv is available at http://circinterventions.ahajournals.org
e33
DOI: 10.1161/CIRCINTERVENTIONS.110.959809
e34
Circ Cardiovasc Interv
October 2011
Table.
Tumor Size by Computed Tomography
Tumor size by
CT, mm
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Figure 4. Control angiography after total embolization of 2nd
and 3rd acute marginal branches and distal segment of the 4th
acute marginal branch show dramatic reduction of the tumor
supply.
Complete surgical resection was difficult because of the
expansion of the tumor at the time of diagnosis. To
minimize the amount of myocardial damage caused by
surgical trauma, we opted to perform coil embolization of
the heart tumor. For the procedure, balloons were placed in
the 2nd and 3rd marginal branches. Flow was occluded for
15 minutes during balloon occlusion. The patient had no
signs of myocardial ischemia during balloon occlusion
as the 2nd, 3rd, and distal segments of the 4th marginal
branch were successfully embolized with Trufill pushable coils (Cordis Neurovascular, Inc, Miami Lakes, FL)
(Figure 4).
Control angiography demonstrated dramatic reduction of
tumor supply (Figure 4).
The patient’s recovery was uneventful, and he was discharged to home the following day. Within 7 days after
discharge, he reported no chest pain and a markedly improved
tolerance to physical activity.
Figure 5. Control coronary angiography shows recanalization of
the embolized segment of 4th acute marginal branch at
1-month follow-up (on the left). The branch was totally embolized with 3 coils (on the right).
Baseline
2-Month
Follow-Up
6-Month
Follow-Up
1-Year
Follow-Up
39⫻85
29⫻63
26⫻61
24⫻59
One month after the procedure, TTE revealed reduction of
the tumor size to 3.5⫻8.3 cm. However, control coronary
angiography showed recanalization of the 4th acute marginal
branch. Therefore, the branch was reembolized with 3 Trufill
pushable coils (Cordis Neurovascular, Inc, Miami Lakes, FL)
(Figure 5).
At 2-month follow-up, the patient’s clinical status dramatically improved: frequency and intensity of chest pain was
significantly reduced, and tolerance to general physical activity was nearly normal (confirmed by treadmill exercise
stress test). Control echocardiography and CT showed significant reduction of the tumor size and enlargement of the RV
volume (Table).
At 6-month and 1-year follow-up, the patient had no chest
pain and normal tolerance to general physical activity. TTE
and CT showed further reduction of tumor size (Table and
Figure 6).
Further control TTE every 6 months and yearly CT and
follow-up is planned.
Summary
To the best of our knowledge, this is the first reported case of
endovascular treatment of a cardiac tumor.
Coil embolization was successfully performed and provided a less invasive treatment alternative to the surgical
treatment to preserve the myocardium. Further comparative
long-term data are needed to evaluate the efficacy of coil
embolization for treatment of a cardiac tumor.
Figure 6. The size of the mass was reduced to 24⫻59 mm
by contrast-enhanced computed tomography at 1-year
follow-up.
Kipshidze et al
Disclosures
None.
References
1. Cohn LH. Cardiac neoplasms. In: Cardiac Surgery in the Adult. Columbus,
OH: McGraw-Hill Medical; 2008:1479 –1509.
2. Reynen K. Cardiac myxomas. N Engl J Med. 1995;333:1610.
Endovascular Treatment of RV Tumor
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3. Burke A, Virmani R. Tumor of the Heart and Great Vessels. In Atlas of
Tumor Pathology. Berlin, Germany: Springer-Verlag GmbH; 1996:1–98.
4. Vicol C, Wagner T, Danov V, Sumer C, Struck E. Clinical, anatomicalpathological and therapeutic correlates of benign intracavitary heart
tumors. Chirurg. 1998;69:1357–1361.
KEY WORDS: coil embolization
ventricular tumor
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transcatheter
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heart tumor
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right
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Endovascular Treatment of Right Ventricular Tumor
Nicholas Kipshidze, Akaki Archvadze, Vakhtang Kipiani, Zaza Katsitadze, Zviad Matoshvili
and Ulrich Sigwart
Downloaded from http://circinterventions.ahajournals.org/ by guest on May 12, 2017
Circ Cardiovasc Interv. 2011;4:e33-e35
doi: 10.1161/CIRCINTERVENTIONS.110.959809
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