A 43-year-old man was admitted to the emergency department with symptoms of lower extremity edema and decreased activity tolerance with progressive dyspnea. Echocardiography showed right ventricular inflow tract obstruction due to a massive right ventricular mass (size: 90 mm × 65 mm × 52 mm). The right ventricle was almost completely occupied by the mass (Fig. 1a). Urgent resection of the right ventricular mass was planned. In the RV inflow–outflow view, the patient had a narrow gap of approximately 6 mm between the mass and supraventricular crest (Fig. 1b). Since the angle of blood flow and the sampling line were perpendicular, Doppler echocardiography was not suitable for the detection of blood flow velocity. Fusion and wrapping of the anterior and posterior tricuspid valves were observed and only the septal valve was active (Fig. 1c). The supraventricular crest of the right ventricle is a rounded accentuation of its muscular wall that demarcates the inflow and outflow tracts [1]. The tumor mainly occupied the space from the tricuspid valve to the supraventricular crest causing obstruction of the inflow tract. Median thoracotomy under cardiopulmonary bypass was urgently performed. The anterior and posterior valves of the tricuspid valve were completely invaded by the mass and were difficult to separate. Tricuspid bioprosthetic valve replacement was performed. The mass occupied the entire right ventricle and infiltrated the endocardium and myocardium and could not be completely resected because of the extensive local invasion. An image of the excised fragmented tumor tissue is shown in Fig. 1d.
Fig. 1
a Transthoracic echocardiography showed a huge mass (yellow arrow) occupying the inflow tract and most of the right ventricular cavity. b In the mid-esophageal RV inflow–outflow view, the mass was closely related to the right ventricular free wall (yellow arrow) and the patient had only a narrow gap of approximately 6 mm between the tumor and the supraventricular crest to provide forward blood flow during diastole. c The mass fused and wrapped with the anterior and posterior tricuspid valves, and the demarcation between the tumor and the myocardium was not clear (yellow arrow). d The excised fragmented tumor tissue. The findings of the pathological examination suggested leiomyosarcoma. LA left atrium, LV left ventricle, RA right atrium
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