ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Çok nadir ve dev kavernöz kalp hemanjiyomu
Alireza Alizadeh Ghavidel1, Sedigheh Saedi2, Nicholas Austine3, Kambiz Mozafari4
1Department of Cardiovascular Surgery, Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
2Department of Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
3Editorial Board of Multidisciplinary Cardiovascular Annals, Iranian Society of Cardiac Surgeons, Tehran, Iran
4Department of Pathology, Rajaie Cardiovascular, Medical and Research Center, Tehran, Iran
DOI : 10.5606/tgkdc.dergisi.2020.18902

Cardiac hemangioma is an extremely rare phenomenon which accounts for only 5 to 10% of cardiac benign tumors with fewer than 100 cases around the globe.[1,2] A cardiac hemangioma can cause congestive heart failure, outflow tract obstruction, coronary insufficiency, and even sudden death.[3]

Herein we depict a very rare case of cardiac hemangioma. A 65-year-old female patient presented with exertional dyspnea and palpitation for a couple of weeks. Her past medical history was unremarkable. She had normal vital signs and physical examination findings. There were no pathological findings in the laboratory analysis. Chest X-ray showed cardiomegaly, particularly in the left cardiac border. Echocardiography revealed a huge well-defined cardiac mass in the anterolateral side of the left ventricle and normal ventricular function without a significant valvular problem. Spiral computed tomography and cardiac magnetic resonance imaging revealed a huge, well-defined solid mass adjacent to the left anterior descending artery and very close to the obtuse marginal branch which was compatible with a benign tumor most probable with hemangioma (Figure 1). Metastasis testing work-up was also unremarkable. En bloc resection of the encapsulated huge solid tumor (12x10.3 cm) was performed by a sharp dissection and electrocautery under cardioplegic arrest with preserving the adjacent coronary arteries. The patient"s postoperative course was uneventful. Histopathological examinations showed a cavernous cardiac hemangioma (Figure 2). The arrows in Figure 2D show the dilated vascular spaces lined by a flat endothelium containing red blood cells, which is the characteristic feature of cavernous cardiac hemangioma.

Figure 1: Different preoperative cardiac imaging modalities; (a) Chest X-ray; (b) Sagittal view of cardiac magnetic resonance; (c) Coronal view of magnetic resonance; (d) Echocardiographic four-chamber view; (e) Anatomic relationship between the mass and left circumflex artery; (f) Anatomic relationship between the mass and left anterior descending artery. LV: Left ventricle; CMR: Cardiac magnetic resonance.

Figure 2: (a) Surgical view of the huge epicardial mass; (b) Surgical en bloc resection of the mass; (c) Final result of surgical excision after repairing epicardial tissue; (d) Histopathological findings (Dilated vascular spaces lined by a flat endothelium containing red blood cells).
LAD: Left anterior descending.

Declaration of conflicting interests
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Funding
The authors received no financial support for the research and/or authorship of this article.