Case report

A 50 year old female patient with a background of systemic lupus erythrematosus presented to various hospitals with chest pain and shortness of breath over the last three years. The history was also significant for sweats, low grade temperatures and weight loss of seven kilograms. Unfortunately, despite multiple imaging attempts, a diagnosis was not made until recently when a trans-thoracic echocardiogram showed the presence of a mass either arising from the pericardium or ventricle. A left video assisted thoracoscopic (VAT) pericardial window and biopsy of the mass was done which did not show any evidence of malignancy.
A re-presentation with heart failure prompted a trans-oesophageal echocardiogram which demonstrated a mass compressing the left ventricle. A coronary angiogram was normal apart from feeding vessels into the tumour. Due to the multiple hospital admissions and new heart failure, a decision was made to excise the tumour.
A median sternotomy was performed and the patient placed on aorto-atrial bypass. A large mass arising from the left ventricle was mobilised (Figure 1) Cardioplegic arrest allowed a full thickness ventriculotomy and subsequent removal of the tumour. The defect was repaired with a continuous 2-0 Prolene stitch followed by overlocking 4-0 Prolene with a Teflon buttress.
The phrenic nerves were spared bilaterally. The patient was easily weaned off cardiopulmonary bypass but had to have the chest packed due to generalised coagulopathy. The chest was unpacked and closed primarily the following day after which she made an uneventful post-operative recovery.
Docetaxel and Gemcitabine chemotherapy was started by the treating oncology team after discharge from hospital.