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Image in Cardiology
Transpulmonary resection of an interventricular septal fibroma in an adult patient
Resseção transpulmonar de um fibroma do septo interventricular num doente adulto
Sílvia Leãoa,
Corresponding author
silvia.carneiro.leao@gmail.com

Corresponding author.
, Paulo Fontesa, Mário Amorimb, Ilídio Moreiraa
a Department of Cardiology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
b Faculty of Medicine of Porto University, Physiology and Cardiothoracic Surgery, Porto, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 39-year-old woman was referred to our institution for a cardiac mass discovered incidentally during transthoracic echocardiography performed for unrelated reasons&#46; She was asymptomatic and the physical examination was normal&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">To further characterize the mass&#44; she underwent magnetic resonance imaging &#40;MRI&#41;&#46; The study revealed a solid nodular intramyocardial tumor &#40;3&#46;2 cm&#215;2&#46;2 cm&#215;1&#46;6 cm&#41; located within the basal interventricular septum &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#41;&#46; The lesion was isointense in T1-weighted sequences and hypointense in T2-weighted sequences &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C and D&#41;&#46; There was no perfusion within the tumor on first-pass gadolinium perfusion images and heterogeneous late gadolinium enhancement was evident &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41;&#46; Computed tomography excluded calcifications within the tumor&#46; A diagnosis of fibroma was considered&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Taking into account the uncertainty concerning the nature of the tumor&#44; right ventricular outflow tract &#40;RVOT&#41; obstruction and high risk of malignant arrhythmias&#44; the patient underwent surgical resection&#46; The tumor was resected through a pulmonary artery approach &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>E and F&#41;&#44; avoiding right ventricular &#40;RV&#41; myectomy&#46; The intraoperative and postoperative course was uneventful&#46; Pathologic examination confirmed the diagnosis of fibroma&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">After a six-month follow-up&#44; the patient was asymptomatic and MRI showed no evidence of tumor recurrence or RVOT obstruction &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>G&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Cardiac fibromas are extremely rare in adults&#46; MRI provides valuable information for their diagnosis and management&#46; Surgical resection is the gold standard when symptomatic&#46; In asymptomatic patients&#44; the choice between surgical and conservative management is controversial and should take into account the risk of sudden cardiac death and the likelihood of technical complications of surgery&#46; Avoiding RV myectomy can obviate potential late RV arrhythmias&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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ISSN: 21742049
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Revista Portuguesa de Cardiologia (English edition)
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