Case presentation
A 46 year old female patient present to emergency with decompensated
heart failure with cardiogenic shock and renal shutdown. She is known
case of chronic kidney disease (stage 4) on medication and one episode
of thromboembolic cerebrovascular accident (right fronto-parietal
infarct) 2 month ago.
After initial medical optimization echocardiography was done.On
echocardiography (Figure 1)) 1.9x1.7 cm pedunculated mobile mass in left
ventricle which is attached to intraventricular septum with left
ventricular ejection fraction 40-45%. On cardiac MRI (Figure 2)
isointense lesion in left ventricle which is attach to endocardium
through a narrow pedicle. As per institutional protocol coronary
angiography done and on angiography mid part of left anterior desceding
(LAD) artery is 70 to 80 percent stenosed and posterior descending
artery(PDA) is 80 percent stenosed.
Patient was taken for surgery. (Figure 3) After sternotomy left internal
mammary artery and right sided great saphenous vein (RSVG) were
harvested. After heparinization aorto bicaval cannulation was done and
cross clamp was applied. Right atrium was opened atrial septum was
incised. Then left ventricular mass was resected and intraatrial septum
and right atrium was closed .RSVG was anastomosed to PDA and ascending
aorta and LIMA was anatomosed to LAD. Then gradually crossclamp was off
and decannilation was done. After application of intercostals drain and
pacing wire sternum was closed.Immediately after operation ventilation
time was 12 hours and vasoactive inotropic score was 28. Intensive care
unit stay and hospital stay were 4 days and 7 days respectively.
Histopathology of the tumour revealed fibrin deposition with
eosinophilic amorphous material in the centre with periphery of the
lesion showing calcification. No myxomatous tissue was seen (Figure 4)
On 6 month followup there was no recurrent mass and functional status of
the patient was NYHA II.