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
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class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Ilídio" "apellidos" => "Moreira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Cardiology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculty of Medicine of Porto University, Physiology and Cardiothoracic Surgery, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Resseção transpulmonar de um fibroma do septo interventricular num doente adulto" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1201 "Ancho" => 1800 "Tamanyo" => 261481 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Cine magnetic resonance imaging (MRI), short-axis view; (B) MRI, late gadolinium enhancement; (C) T1-weighted MRI; (D) T2-weighted MRI; (E) surgical approach through the pulmonary artery; (F) macroscopic appearance of the tumor; (G) follow-up MRI, late gadolinium enhancement.</p>" ] ] ] "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. She was asymptomatic and the physical examination was normal.</p><p id="par0010" class="elsevierStylePara elsevierViewall">To further characterize the mass, she underwent magnetic resonance imaging (MRI). The study revealed a solid nodular intramyocardial tumor (3.2 cm×2.2 cm×1.6 cm) located within the basal interventricular septum (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A). The lesion was isointense in T1-weighted sequences and hypointense in T2-weighted sequences (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C and D). There was no perfusion within the tumor on first-pass gadolinium perfusion images and heterogeneous late gadolinium enhancement was evident (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B). Computed tomography excluded calcifications within the tumor. A diagnosis of fibroma was considered.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Taking into account the uncertainty concerning the nature of the tumor, right ventricular outflow tract (RVOT) obstruction and high risk of malignant arrhythmias, the patient underwent surgical resection. The tumor was resected through a pulmonary artery approach (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>E and F), avoiding right ventricular (RV) myectomy. The intraoperative and postoperative course was uneventful. Pathologic examination confirmed the diagnosis of fibroma.</p><p id="par0020" class="elsevierStylePara elsevierViewall">After a six-month follow-up, the patient was asymptomatic and MRI showed no evidence of tumor recurrence or RVOT obstruction (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>G).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Cardiac fibromas are extremely rare in adults. MRI provides valuable information for their diagnosis and management. Surgical resection is the gold standard when symptomatic. In asymptomatic patients, 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. Avoiding RV myectomy can obviate potential late RV arrhythmias.</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.</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.</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. The corresponding author is in possession of this document.</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.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-10-03" "fechaAceptado" => "2015-11-23" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1201 "Ancho" => 1800 "Tamanyo" => 261481 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Cine magnetic resonance imaging (MRI), short-axis view; (B) MRI, late gadolinium enhancement; (C) T1-weighted MRI; (D) T2-weighted MRI; (E) surgical approach through the pulmonary artery; (F) macroscopic appearance of the tumor; (G) follow-up MRI, late gadolinium enhancement.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003500000009/v1_201608170044/S0870255116301408/v1_201608170044/en/main.assets" "Apartado" => array:4 [ "identificador" => "29264" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Imagens em Cardiologia" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003500000009/v1_201608170044/S0870255116301408/v1_201608170044/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116301408?idApp=UINPBA00004E" ]
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