Case presentation
A 46 year old female patient present to emergency with decompensated heart failure with cardiogenic shock and renal shutdown. She is known case of chronic kidney disease (stage 4) on medication and one episode of thromboembolic cerebrovascular accident (right fronto-parietal infarct) 2 month ago.
After initial medical optimization echocardiography was done.On echocardiography (Figure 1)) 1.9x1.7 cm pedunculated mobile mass in left ventricle which is attached to intraventricular septum with left ventricular ejection fraction 40-45%. On cardiac MRI (Figure 2) isointense lesion in left ventricle which is attach to endocardium through a narrow pedicle. As per institutional protocol coronary angiography done and on angiography mid part of left anterior desceding (LAD) artery is 70 to 80 percent stenosed and posterior descending artery(PDA) is 80 percent stenosed.
Patient was taken for surgery. (Figure 3) After sternotomy left internal mammary artery and right sided great saphenous vein (RSVG) were harvested. After heparinization aorto bicaval cannulation was done and cross clamp was applied. Right atrium was opened atrial septum was incised. Then left ventricular mass was resected and intraatrial septum and right atrium was closed .RSVG was anastomosed to PDA and ascending aorta and LIMA was anatomosed to LAD. Then gradually crossclamp was off and decannilation was done. After application of intercostals drain and pacing wire sternum was closed.Immediately after operation ventilation time was 12 hours and vasoactive inotropic score was 28. Intensive care unit stay and hospital stay were 4 days and 7 days respectively.
Histopathology of the tumour revealed fibrin deposition with eosinophilic amorphous material in the centre with periphery of the lesion showing calcification. No myxomatous tissue was seen (Figure 4)
On 6 month followup there was no recurrent mass and functional status of the patient was NYHA II.