Grønlund, Jens

Joseph, Gowsini

Zaremba, Tomas

Zelechowski, Marek

English

VBN (Videnbasen)  Aalborg Universitets forskningsportal

    Aalborg UniversitetTo remove or not to remove?The role of echocardiography and cardiac magnetic resonance in decision making on cardiacsurgery in a patient with cardiac tumourJoseph, Gowsini; Zelechowski, Marek; Grønlund, Jens; Zaremba, TomasPublication date:2018Document VersionPublisher's PDF, also known as Version of recordLink to publication from Aalborg UniversityCitation for published version (APA):Joseph, G., Zelechowski, M., Grønlund, J., & Zaremba, T. (2018). To remove or not to remove? The role ofechocardiography and cardiac magnetic resonance in decision making on cardiac surgery in a patient withcardiac tumour. Poster presented at EuroEcho Imaging 2018, Milano, Italy.General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright ownersand it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.            ? Users may download and print one copy of any publication from the public portal for the purpose of private study or research.            ? You may not further distribute the material or use it for any profit-making activity or commercial gain            ? You may freely distribute the URL identifying the publication in the public portal ?Take down policyIf you believe that this document breaches copyright please contact us at vbn@aub.aau.dk providing details, and we will remove access tothe work immediately and investigate your claim.Downloaded from vbn.aau.dk on: November 24, 2020ConclusionCMR provides paramount information on the diagnostic accuracy of cardiac tumours and determines the choice of cardiac surgery. Exact pre-operative diagnosis can avoid unnecessary cardiac surgery. Currently, there is no official statement on the role of different cardiac imaging modalities in diagnostic evaluation of cardiac tumours. Meanwhile, CMR should be considered as a routine supplemental imaging modality in the assess-ment of patients with cardiac mass.BackgroundAccurate diagnostic evaluation of cardiac tumours remains a clinical challenge. Cardiac surgery without pre-operative pre-cise diagnosis could have disastrous consequences for the patient. The diagnosis and decision on cardiac surgery is usually based on the morphological findings on echocardiography without further additional imaging modalities. Although cardiac magnetic resonance (CMR) is a well-established non-invasive imaging modality, statement on the role of CMR in this field is lacking. PurposeWe present a clinical case where CMR had crucial importance in decision making on surgical removal in a patient with a car-diac mass.  The scheduled cardiac surgery on assumed myxoma was withdrawn because of pre-operative CMR-findings.Methods & Results67 years old female without previous cardiac history was admitted with palpitations. Electrocardiogram showed regular su-praventricular tachycardia at a ventricular rate of 213 bpm. Conversion to sinus rhythm was achieved by intravenous admin-istration of 300mg Amiodarone. Transthoracic echocardiogram and subsequent transoesophageal echocardiogram showed a solid mass sized 5 x 3 cm in the right atrium attached to the intra-atrial septal wall. There was no affection of the tricuspid valve and no hemodynamic obstruction of the atrial cavity, inferior, or superior caval vein. Left ventricular function, right ven-tricular function, and all heart valves were without pathological findings. The tumour was reported as a right-sided myxoma and the patient was referred to cardio-thoracic surgery. There was no evidence of embolic phenomena. The episode of su-praventricular tachycardia was concluded to be the first and single symptom of the tumour. To rule out the presence of coronary stenosis prior to cardiothoracic surgery, coronary CT-angiography was performed con-cluding normal coronary arteries. Second review of the echocardiographic images at the heart team conference drew atten-tion to the tumour`s broad based attachment to the intra-atrial septal wall, reduced mobility and absence of a narrow stalk. CMR was requested. CMR with T1- and T2-weighted images including fat suppression and gadolinium-based contrast re-vealed that the solid mass consisted of widespread lipomatous hypertrophy of the intra-atrial septum due to fatty infiltration. The scheduled surgery was cancelled. The patient started oral anticoagulation therapy and treatment with beta-blocker. It was decided not to perform radiofrequency ablation procedure.        Gowsini Joseph* (1,2), Marek Zelechowski (2), Jens Gronlund (3), Tomas Zaremba (4)(1) Department of Clinical Medicine, Aalborg University, Denmark (2) Department of Cardiology, North Denmark Regional Hospital, Denmark(3) Department of Cardiothoracic Surgery, Aalborg University Hospital, Denmark(4) Department of Cardiology, Aalborg University Hospital, Denmark*Corresponding author: Gowsini Joseph, e-mail: g.joseph@rn.dkTransoesophageal images of Lipomatous hypertrophy of the intra-atrial septumCMR images of Lipomatous hypertrophy of the intra-atrial septumTo remove or not to remove?The role of echocardiography and cardiac magnetic resonance in decision making on cardiac surgery in a patient with cardiac tumour

To remove or not to remove?:The role of echocardiography and cardiac magnetic resonance in decision making on cardiac surgery in a patient with cardiac tumour

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To remove or not to remove?:The role of echocardiography and cardiac magnetic resonance in decision making on cardiac surgery in a patient with cardiac tumour

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