Life-threatening arrhythmias from dynamic LVOT obstruction by a large left ventricular fibroma in an adolescent: complete resolution after combined transaortic-transatrial resection—a case report

Figures

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  Figure 1. CTA imaging of the left ventricular fibroma causing dynamic LVOT obstruction. Preoperative CTA offered detailed visualization of the left ventricular fibroma across sagittal, horizontal, and coronal planes (red arrow), revealing its dimensions measuring approximately 5.22 cm × 2.48 cm × 2.34 cm (A–C). Subsequent 3D coronary reconstruction clearly delineated all branches, revealing no evidence of vascular compression or invasion by the fibroma and no signs of blood flow obstruction (D).

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  Figure 2. TEE findings and confirmation of complete resection. Intraoperative TEE revealed a tumor projecting prominently into the left ventricular outflow tract during systole (long-axis view), partially crossing the aortic valve and causing severe outflow tract obstruction (as indicated by the red arrow). Continuous Doppler measurements demonstrated a peak left ventricular outflow tract flow velocity of 4.94 m/s and a mean transvalvular pressure gradient of 99 mmHg, with prominent high-velocity turbulent mixed signals (A) The tumor was attached to the mid-ventricular septum via a pedicle. During diastole (four-chamber view), the mass retreated into the left ventricle and significantly obstructed the opening of the mitral valve's anterior leaflet (B) Postoperative TEE demonstrated successful resolution of left ventricular outflow tract obstruction, with complete disappearance of subaortic outflow tract color turbulence signals. The maximum flow velocity in the ventricular outflow tract decreased to 0.95 m/s, and the mean transvalvular pressure difference was 4 mmHg (C) The ventricular septum remained continuous and intact, with homogeneous surface echogenicity. The anterior leaflet of the…

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  Figure 3. Histopathological confirmation of cardiac fibroma. Intraoperative view after aortotomy showing the tumor extending into the LVOT (A). Resected specimen demonstrating a hematoma at the free end (red arrow) and the distal pedicle (white arrow) (B). Histological sections (H&E staining) revealing dense collagenous tissue with cystic degeneration, vascular proliferation, focal hemorrhage, and thrombosis (C,D).