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Logo of thijTexas Heart Institute JournalSee also Cardiovascular Diseases Journal in PMCSubscribeSubmissionsTHI Journal Website
 
Tex Heart Inst J. 2007; 34(1): 128–129.
PMCID: PMC1847915

Large Left Ventricular Capillary Hemangioma with Cavernous Areas

Raymond F. Stainback, MD, Section Editor
Department of Adult Cardiology, Texas Heart Institute and St. Luke's Episcopal Hospital, 6624 Fannin Street, Suite 2480, Houston, TX 77030

A 34-year-old man presented with palpitations, headaches, and a history of supraventricular arrhythmias. Transesophageal and transthoracic echocardiography and magnetic resonance imaging (Fig. 1) showed a large non-pedunculated mass in the inferoposterior and lateral walls of the left ventricle. Coronary angiography and left ventriculography showed normal coronary vessels and a large filling defect in the aforementioned walls of the left ventricle. The mass was supplied primarily by the circumflex coronary artery and partially by the right coronary artery (Fig. 2).

figure 30FF1
Fig. 1 Left ventricular magnetic resonance image of a capillary hemangioma, with cavernous areas. The axial T2-weighted image at the ventricular level shows a high-signal mass projecting within the left ventricle (large arrow) and the transmural location ...
figure 30FF2
Fig. 2 A) Coronary angiography shows that the mass is supplied by the circumflex coronary artery. B) Left ventriculography shows the large filling defect from the mural, non-pedunculated mass in the inferoposterior and lateral walls of the left ventricle. ...

Under bicaval, normothermic cardiopulmonary bypass and crystalloid cardioplegic arrest, the patient underwent complete removal of a solid transmural tumor (4 × 6 × 4 cm). The tumor originated in the endocardium between the anterior and posterior papillary muscles of the mitral valve, and it extended through the myocardium to the epicardium. The marginal branches of the circumflex coronary artery were ligated during the excision. The cardiac defect, enormous for an otherwise normal ventricle, was closed primarily in 2 layers with Teflon felt pledgets, as in aneurysmal repair. The microscopic diagnosis was mural capillary hemangioma of the heart, with cavernous areas, and without evidence of malignancy (Figs. 3 and and44).

figure 30FF3
Fig. 3 Macroscopic view of the tumor (dimensions, 4 × 6 × 4 cm).
figure 30FF4
Fig. 4 Photomicrograph of a representative area of the tumor. Numerous and relatively uniform capillary-sized vessels are arranged in groups. A mild inflammatory reaction is also present.

The patient's postoperative course was uneventful, with no compromise in ventricular or valvular function despite the tumor's proximity to the papillary muscles of the mitral valve. He was discharged from the hospital on the 6th postoperative day. Over the last 8 years, the patient has undergone serial follow-up echocardiography; the results have shown mitral sufficiency, satisfactory ventricular function, and no recurrence of the tumor.

Comment

Hemangiomas of the heart comprise 5% to 10% of benign cardiac tumors in surgical series1; fewer than 100 surgically discovered cases have been reported in the world literature. Histologically, hemangiomas are classified as cavernous, capillary, and arteriovenous.1 They are localized in the atria, the ventricles, the ventricular septum, the pericardium, and very rarely the mitral valve. They can reach a large size, and, in 75% of cases, they are mural. Although most hemangiomas are asymptomatic, they can present with arrhythmias, conduction disturbances, pericardial effusion, coronary insufficiency, outflow tract obstruction, or congestive heart failure. Sudden cardiac death, consequent to conduction disturbances or rupture and tamponade, has been reported.1,2 Echocardiography is a sensitive diagnostic method3,4 that can be supplemented by coronary angiography, ventriculography, and magnetic resonance imaging.5–7 The differential diagnosis is myxoma or hemangiosarcoma. When diagnosed, hemangiomas should be removed because of the possibility of rupture8,9 and tamponade.10 In most cases, as with our patient, excision is considered curative.

Footnotes

Address for reprints: Kyriakos St. Rammos, MD, 29 Karolou Diehl str., Thessaloniki 54623, Greece. E-mail: rg.tenhtrof.eht@sommar

References

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8. Abad C, Campo E, Estruch R, Condom E, Barriuso C, Tassies D, Pare JC. Cardiac hemangioma with papillary endothelial hyperplasia: report of a resected case and review of the literature. Ann Thorac Surg 1990;49:305–8. [PubMed]
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Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute