Left ventricular hemangioma and quadricuspid aortic valve: a rare combination

Excerpt

A 35-year-old man was admitted to our hospital with palpitation for 3 months. Physical examination revealed a grade IV/VI diastolic murmur, which was audible at the left sternal border. The chest X-ray showed no abnormal findings. Transthoracic echocardiography (TTE) demonstrated normal left ventricular function (ejection fraction: 68%), a quadricuspid aortic valve with mild to moderate regurgitation (Fig. 1a–c, Supplemental Video 1). In addition, an immobile hyperechoic mass (53 × 29 mm) arising from the left ventricular lateral wall near the apex was also noted (Fig. 1d, e, Supplemental Video 2). On color Doppler flow imaging, the small amount of blood flow signal was observed in the mass (Fig. 1f). Contrast echocardiography indicated hyperenhancement of contrast agent in the mass (Fig. 1g, Supplemental Video 3), suggesting the mass appeared to be hypervascularized. Computed tomography (CT) confirmed the presence of the LV mass (Fig. 1h, i). Positron emission tomographic (PET)/CT revealed no ¹⁸F-fluorodeoxyglucose uptake in the mass (Fig. 1j). Due to mild to moderate aortic regurgitation and surgical indications for quadricuspid aortic valve were not well established. The patient underwent surgical resection of the LV mass under total cardiopulmonary bypass. A soft and immobile mass in the left ventricle, measuring 60 × 30 mm, was confirmed. Histopathological examination of the mass showed hemangioma (Fig. 1K-M). He had an uneventful recovery and was discharged home in good condition 1 week after surgery. At the 12-month follow-up, the patient was well without evidence of tumor recurrence.

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