ABSTRACT
INTRODUCTION: Cardiac hemangiomas are rare benign primary tumors.We present the successful management of a patient with a hemangioma causing significant right ventricular outflow tract (RVOT) obstruction.CLINICAL PRESENTATION: A 54-year-old female with no co-morbidities presented with progressive right-sided heart failure symptoms.Examination revealed a prominent right ventricular heave, irregular cardiac rhythm,murmurs consistent with pulmonic stenosis and tricuspid regurgitation, ascites, and bipedal edema. Given the echo features of the mass and the patient's clinical course,we favored a benign cardiac tumor over malignancy.Differentials included myxoma, fibroma, and papillary fibroelastoma. Medical management included enoxaparin and carvedilol as anticoagulation and rate control for the atrial flutter, respectively. Surgical treatment consisted of tumor excision and tricuspid valve annuloplasty.RESULTS: Intra-operatively, the stalk was indeed attached to the RV free wall. Histopathology was consistent with primary cardiac hemangioma. The patient's post-operative course was complicated by pneumonia, acute kidney injury, and tracheostomy, but she was eventually discharged improved after a month in the ICU.SIGNIFICANCE: This report highlights a rare primary cardiac tumor in an unusual location. While there have been several reports in the world literature on cardiac hemangiomas, less than ten cases have been shown to have significant RVOT obstruction as in our patient.CONCLUSION: Cardiac hemangiomas should be part of the differential diagnosis for an intracardiac mass in the right ventricle. Meticulous echocardiography can be a non-invasive and inexpensive aid to diagnosis and pre-operative planning.