Zhao Yixin, Li Guoliang, Wang Shun, Yan Yang
Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, PR China.
Arrhythmia Unit, Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, PR China.
Eur Heart J Case Rep. 2021 Jul 30;5(7):ytab260. doi: 10.1093/ehjcr/ytab260. eCollection 2021 Jul.
Cardiac lipomas are rare benign primary tumours of the heart. Due to the nature of these tumours, they are often asymptomatic and diagnosed incidentally. Whether asymptomatic patients with cardiac lipomas should perform surgery still remains controversial.
A 34-year-old Asian male who was incidentally found hyperechoic masses in the right ventricle (RV) on the transthoracic echocardiogram by annually routine physical examination was admitted to our cardiology department. His medical history was unremarkable. The repeated transthoracic and transoesophageal echocardiogram showed multiple solitary and well-demarcated masses in the RV. On the cardiac magnetic resonance imaging, four discrete masses (considering the possibility of it being a lipoma) partially occluding the right ventricular outflow tract (RVOT) were observed. During the open-heart resection surgery, it was found that the tricuspid valve and papillary muscle were covered by multiple adipose masses in the RV that arose from the interventricular septum and the free wall, resulting in partial RVOT obstruction. These excised masses were histopathologically confirmed as lipomata characterized by the mature adipocytes with entrapped myocardial cells. The patient had no cardiac abnormality in the 1-month follow-up after the surgery.
This rare clinical case of multiple lipomata of the tricuspid valve and papillary muscle acknowledges that multimodality imaging is the cornerstone for the assessment and diagnosis. Surgery should be performed in cases of symptomatic or large lipomas as well as when a lipoma is considered to be high risk because of RVOT obstruction.
心脏脂肪瘤是罕见的原发性心脏良性肿瘤。由于这些肿瘤的性质，它们通常无症状，多为偶然发现。无症状的心脏脂肪瘤患者是否应进行手术仍存在争议。
一名34岁的亚洲男性，每年例行体检时经胸超声心动图偶然发现右心室有高回声团块，遂入住我院心内科。他的病史无特殊。经反复经胸和经食管超声心动图检查，发现右心室有多个孤立且边界清晰的团块。心脏磁共振成像显示，有四个离散的团块（考虑为脂肪瘤的可能性）部分阻塞右心室流出道。在心脏直视切除手术中，发现右心室的三尖瓣和乳头肌被多个脂肪团块覆盖，这些团块起源于室间隔和游离壁，导致右心室流出道部分梗阻。切除的团块经组织病理学证实为脂肪瘤，其特征为含有包埋心肌细胞的成熟脂肪细胞。术后1个月随访，患者心脏无异常。
这例罕见的三尖瓣和乳头肌多发性脂肪瘤临床病例表明，多模态成像检查是评估和诊断的基石。对于有症状的脂肪瘤、较大的脂肪瘤以及因右心室流出道梗阻而被认为具有高风险的脂肪瘤，均应进行手术治疗。
