We report the case of an asymptomatic 43-year-old-man with a lipoma of the interventricular septum. Diagnosis was established during routine medical examination by 2-dimensional echocardiography and confirmed by computed tomography and magnetic resonance imaging. the patient underwent successful resection of the tumor.Relatamos o caso de um homem de 43 anos, assintomático, portador de um lipoma do septo interventricular, diagnosticado durante exame médico de rotina, por meio de ecocardiograma bidimensional e confirmado por tomografia computadorizada e ressonância magnética. O paciente foi submetido, com sucesso, à ressecção do tumor.Escola Paulista Med, São Paulo, BrazilEscola Paulista Med, São Paulo, BrazilWeb of Scienc

Figueira, Fernando Augusto Marinho dos Santos

Moraes, Carlos Roberto Ribeiro de

Brazilian Journal of Cardiovascular Surgery

Figueira, Fernando Augusto Marinho dos Santos [UNIFESP]

Repositório Institucional UNIFESP

5911. Resident Physician in Cardiovascular Surgery at INCOR-PE.2. Phd from Paulista School of Medicine, Director and Surgeon atINCOR-PE.3. President and Surgeon at INCOR-PE.Work performed at the Heart Institute of Pernambuco (INCOR-PE).Real Portugues de Beneficiencia Hospital in Pernambuco, Recife,Brazil.Fernando FIGUEIRA1, Fernando MORAES NETO2, Carlos Roberto Ribeiro de MORAES3Rev Bras Cir Cardiovasc 2010; 25(4): 591-593CASE REPORTRBCCV 44205-1233Ressecção de lipoma do septo interventricularLipoma resection of the interventricular septumMailing address:Carlos Roberto Ribeiro de Moraes.163 Portugal Avenue, Recife, Pernambuco, Brazil.Zip Code: 52010-010.E-mail: cmoraes@uol.com.brArticle received on March 25th, 2010Article approved July 14th, 2010AbstractWe reported the case of an asymptomatic 43-year-old-man with a lipoma of the interventricular septum. Diagnosiswas established during routine medical examination by 2-dimensional echocardiography and confirmed by computedtomography and magnetic resonance imaging. The patientunderwent successful resection of the tumor.Descriptors: Lipoma. Heart neoplasms. Interventricularseptum.ResumoRelatamos o caso de um homem de 43 anos, assintomático,portador de um lipoma do septo interventricular, diagnosticadodurante exame médico de rotina, por meio de ecocardiogramabidimensional e confirmado por tomografia computadorizadae ressonância magnética. O paciente foi submetido, comsucesso, à ressecção do tumor.Descritores: Lipoma. Neoplasias cardíacas. Septointerventricular.INTRODUCTION Primary cardiac tumors are rare, with incidence of 0.2%to 0.4% in autopsy series [1,2]. Around 75% of primarycardiac tumors are benign. Among them, 8% are representedby lipomas [2].Cardiac lipomas are encapsulated tumors composed ofmature fat cells. They are true neoplasms and should bedifferentiated from hypertrophic lipomatosis of the interatrialseptum, in which there is deposition of non-encapsulatedmature and fetal adipose tissue [3].Lipomas of the heart can be epimyocardial, intracavitaryor intramyocardial and may be located in the atria orventricles.In this paper, we reported a rare case of surgical resectionof intramyocardial lipoma located in the interventricularseptum. CASE REPORT  Male patient, 43 years old, asymptomatic, sedentarylife, decided to do a cardiac evaluation considering theintention of going for walks. Taking into account thehistory of this patient, there was reference to the lipomaresection in the left arm at the age of 7. The physicalexamination was normal. Chest X-ray showed normal sizedcardiac silhouette. Electrocardiogram revealed diffusechanges in ventricular repolarization. Echocardiogramshowed a mass located in the basal interventricular septum,measuring 3.2 x 2.2 cm, which did compromise neither thecardiac dynamics nor the intracavitary flows. Chestcomputed tomography confirmed the existence of ahypodense mass, measuring 4.5 x4, 0x4, 0 cm in its largestdiameter, affecting the topography of the interventricularseptum. Magnetic resonance angiography of the heart was592FIGUEIRA, F ET AL - Lipoma resection of the interventricularseptumRev Bras Cir Cardiovasc 2010; 25(4): 591-593carried out, which confirmed the presence of a mass withirregular borders and defined limits, surrounded by a fibrouscapsule measuring 38 x 35 mm, located in the mid-basalportion of the interventricular septum. The images of tissuecharacterization suggested that the mass was consisted ofadipose tissue. It was then surgery indicated. The patientwas also submitted to hemodynamic study and coronaryangiography. The intracavitary pressures were normal, withno significant obstacle observed to ventricular ejection.The coronary arteries were free of obstructive process.The patient was referred to our clinic for surgical treatment,and surgery was performed via median sternotomy withconventional extracorporeal circulation, and myocardialprotection through the aortic root infusion of cold cardioplegicsolution and topical hypothermia of the heart. Longitudinalright ventriculotomy was performed. It was possible to note ayellowish mass embedded in the interventricular septum. Themuscular septum was longitudinally incised (Figure 1), andthe tumor was completely resected (Figure 2). The muscularseptum and the right ventriculotomy were restored withcontinuous prolene 5-0 sutures. In the postoperative period,the patient had excessive bleeding and was submitted tosurgical reexploration. There were two small bleeding spots inthe ventriculotomy, which were sutured. The patient recoveredwith no intercurrence and was discharged on the seventh day,showing no symptoms and without medication.The anatomopathological examination confirmed that itwas a lipoma, measuring 5x4x3, 2 cm, encapsulated andcomposed of mature adipose tissue. DISCUSSION Lipomas of the heart are very rare tumors. Albers wasresponsible for the first report in 1856, and about 60 caseshad been reported until 1995 [4]. Among us, in a series of 50cases of primary cardiac tumors, clinically and histologicallystudied by Fernandes et al. [5], there was only one case oflipoma. The 4 other cases were described in the nationalliterature [6-9].It is also very rare to discover a cardiac tumor in theinterventricular septum, which occurs in only 2% of cases[5]. Therefore, the combination of a rare tumor (lipoma)with a rare location (interventricular septum) is particularlyunusual [10,11].Lipomas occur at any age and the frequency is equal inboth genders. Symptoms vary and may includemanifestations of heart failure, arrhythmia and syncope.Our patient was asymptomatic, and an example of how thedevelopment of modern technology has resulted in morefrequent and accurate diagnosis of cardiac tumors.The diagnosis of cardiac lipoma can be established bybidimensional echocardiography, computed tomographyand magnetic resonance imaging (MRI). MRI is particularlyuseful because it allows the characterization of the tissue.Hemodynamic study and coronary angiography areunnecessary in most cases. In our patient, these tests wereperformed due to age (43 years old), because theelectrocardiogram showed ventricular repolarizationalterations.Fig. 1 - Surgical aspect showing the right ventricle opened and thelipoma being resected after incision in the muscular part of theinterventricular septum Fig. 2 - Lipoma resected.593REFERENCES1. McAllister HA Jr. Tumors of the heart and pericardium. In:Silver MD, ed. Cardiovascular pathology. 2nd ed. NewYork:Churchill Livinstone; 1991. p.1297-333.2. Colucci WS, Schoen FJ, Braunwald E. Primary tumors of theheart. In: Braunwald E, ed. Heart disease: a textbook ofcardiovascular medicine. vol. 2. Philadelphia:WBSaunders;1997. p.1464-77.All cardiac tumors are potentially lethal due to theirpossibility of producing obstruction, embolism and rhythmdisturbances. The security techniques in extracorporealcirculation and myocardial protection are responsible forsafer tumors resection of the heart. Thus, all heart tumorshave indication for surgery, even in asymptomatic patients.The manner to address the tumor depends on its sizeand location. In our case, there was the possibility todeal with the tumor through either right atriotomy orright ventriculotomy. The second option was chosen,because its approach would be more comfortable andsafe through the right ventricle, taking into considerationthe tumor’s size.The tumors excision generally results in cure of patientsand excellent late prognosis.3. Alcocer JJ, Katz WE, Hattler BG. Surgical treatment oflipomatous hypertrophy of the interatrial septum. Ann ThoracSurg. 1998;65(6):1784-6.4. Mullen JC, Schipper SA, Sett SS, Trusler GA. Right atriallipoma. Ann Thorac Surg. 1995;59(5):1239-41.5. Fernandes F, Soufen HN, Ianni BM, Arteaga E, Ramires FJ,Mady C. Primary neoplasms of the heart. Clinical andhistological presentation of 50 cases. Arq Bras Cardiol.2001;76(3):231-7.6. Silveira WL, Nery MW, Soares EC, Leite AF, Nazzetta H,Batista MA, et al. Lipoma de átrio direito. Arq Bras Cardiol.2001;77(4):361-8.7. Pêgo-Fernandes PM, Costa PL, Fernandes F, Benvenuti LA,Oliveira SA. Lipoma atrial direito. Arq Bras Cardiol.2003;80(1):94-6.8. Pêgo-Fernandes PM, Batagello CA, Fernandes F, Jatene FB,Oliveira SA. Lipoma de ventrículo esquerdo: relato de caso.Arq Bras Cardiol. 2004;82(2):188-90.9. Joaquim MR, Braile DM, Arruda MV, Soares MJ. Ressecção deum lipoma de átrio direito e reconstrução parcial com pericárdiobovino. Rev Bras Cir Cardiovasc. 2009;24(2):239-41.10. Nishi H, Mitsuno M, Ryomoto M, Hao H, Hirota S, MiyamotoY. Giant cardiac lipoma in the ventricular septum involving thetricuspid valve. Ann Thorac Surg. 2009;88(4):1337-9.11. Ozaki N, Mukohara N, Yoshida M, Shida T. Cardiac lipoma inthe ventricular septum: a case report. Thorac Cardiovasc Surg.2006;54(5):356-7.FIGUEIRA, F ET AL - Lipoma resection of the interventricularseptumRev Bras Cir Cardiovasc 2010; 25(4): 591-593

Ressecção de lipoma do septo interventricular

http://dx.doi.org/10.1590/S0102-76382010000400026

Ressecção de lipoma do septo interventricular

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