Fibroma cardíaco mimetizando cardiomiopatia hipertrófica

Dallan, Luís Alberto; Oliveira, Sérgio de Almeida; Barreto, Antônio Carlos P; Iglézias, José Carlos Rossini; Verginelli, Geraldo; Jatene, Adib D

doi:10.1590/S0102-76381989000300010

Resumos

É relatado o caso de paciente com queixa de dor precordial, dispnéia e arritmia desde a adolescência, tratada clinicamente por mais de 10 anos. Nesse período, foi submetida a inúmeros exames ângio e ecocardiográficos, com suspeita inicial de endomiocardiofibrose e, posteriormente, de cardiomiopatia hipertrófica de ventrículo esquerdo. Como houve piora progressiva da sintomatologia e ausência de resposta à medicação, foi encaminhada ao nosso Serviço, onde se diagnosticou fibroma de ventrículo esquerdo. Foi submetida, com sucesso, à ressecção cirúrgica do tumor, sendo realizada reconstrução geométrica do ventrículo esquerdo. Apresenta boa evolução, decorridos dois anos, com remissão completa dos sintomas. Destacamos a dificuldade no diagnóstico diferencial desses tumores benignos e de crescimento lento, com as cardiomiopatias hipertróficas do ventrículo esquerdo.

tumores do coração; miocardiopatia hipertrófica

A 33 year-old woman was seen, for the first time, ten years ago, for evaluation of a recurrent chest pain, dyspnea and arrhythmia. She was submitted to echocardiographic studies and a cardiac catheterization. The diagnoses was endomyocardial fibrosis at first, and hypertrophic cardiomyopathy after. Despite treatment with propranolol and quinidine, the episodes of dyspnea and tachyarrhythmias became more frequent and severe, and the patient was guided to our Service. Cardiac re-catheterization, echocardiographic and computed tomography studies identified in traumural cardiac fibroma and the patient was referred for surgical treatment. The cardiac fibroma was successfully resected on extracorporeal bypass and with cardioplegic arrest of the heart. Repair of the heart was accomplished with a patch placed to close the left ventricular cavity. The postoperative course was uncomplicated, and she remains assymptomatic two years later. We have emphazied tha this tumor often produces clinically obscure disease, simulating particularly the left ventricle hypertrophic cardiomiopathy.

tumors of the heart; cardiomiopathy, hypertrophic

RELATOS DE CASO

Fibroma cardíaco mimetizando cardiomiopatia hipertrófica

Cardiac fibroma mimicking hypertrophic cardiomyopathy

Luís Alberto Dallan; Sérgio de Almeida Oliveira; Antônio Carlos P. Barreto; José Carlos Rossini Iglézias; Geraldo Verginelli; Adib D. Jatene

Do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

^{Endereço para separatas} Endereço para separatas: Luís Alberto Dallan Divisão Cirúrgica Av. Dr. Enéas Carvalho de Aguiar, 44 05403 São Paulo, SP, Brasil

RESUMO

É relatado o caso de paciente com queixa de dor precordial, dispnéia e arritmia desde a adolescência, tratada clinicamente por mais de 10 anos. Nesse período, foi submetida a inúmeros exames ângio e ecocardiográficos, com suspeita inicial de endomiocardiofibrose e, posteriormente, de cardiomiopatia hipertrófica de ventrículo esquerdo. Como houve piora progressiva da sintomatologia e ausência de resposta à medicação, foi encaminhada ao nosso Serviço, onde se diagnosticou fibroma de ventrículo esquerdo. Foi submetida, com sucesso, à ressecção cirúrgica do tumor, sendo realizada reconstrução geométrica do ventrículo esquerdo. Apresenta boa evolução, decorridos dois anos, com remissão completa dos sintomas. Destacamos a dificuldade no diagnóstico diferencial desses tumores benignos e de crescimento lento, com as cardiomiopatias hipertróficas do ventrículo esquerdo.

Descritores: tumores do coração; miocardiopatia hipertrófica.

ABSTRACT

A 33 year-old woman was seen, for the first time, ten years ago, for evaluation of a recurrent chest pain, dyspnea and arrhythmia. She was submitted to echocardiographic studies and a cardiac catheterization. The diagnoses was endomyocardial fibrosis at first, and hypertrophic cardiomyopathy after. Despite treatment with propranolol and quinidine, the episodes of dyspnea and tachyarrhythmias became more frequent and severe, and the patient was guided to our Service. Cardiac re-catheterization, echocardiographic and computed tomography studies identified in traumural cardiac fibroma and the patient was referred for surgical treatment. The cardiac fibroma was successfully resected on extracorporeal bypass and with cardioplegic arrest of the heart. Repair of the heart was accomplished with a patch placed to close the left ventricular cavity. The postoperative course was uncomplicated, and she remains assymptomatic two years later. We have emphazied tha this tumor often produces clinically obscure disease, simulating particularly the left ventricle hypertrophic cardiomiopathy.

Descriptors: tumors of the heart; cardiomiopathy, hypertrophic.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido para publicação em 30 de dezembro de 1989.

Trabalho realizado no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil.

1 ARCINIEGAS, E.; HAKINI, M.; FAROOKI, Z. Q.; TRUCCONE, N. J.; GREEN, E. W. - Primary cardiac tumors in children. J. Thorac. Cardiovasc. Surg, 79: 582-591, 1980.
2 BIANCANIELLO, T. M.; MEYER, R. A.; GAUM, W. E.; KAPLAN, S. - Primary benign intramural ventricular rumors in children: pre-and postoperative electrocardiographic, echocardiographic, and angiocardiographic evolution. Am. Heart J, 103: 852-857, 1982.
3 CABIN, H. S.; COSTELLO, R. M.; VASUDEVAN, G.; MARON, B. J.; ROBERTS, W. C. - Cardiac lymphome mimicking hypertrophic cardiomyopathy. Am. Heart J, 102: 466-468, 1981.
4 CHITWOOD, W. R. - Cardiac neoplasms: current diagnosis, pathology, and therapy. J. Cardiac. Surg, 3: 119-154, 1988.
5 DALLAN, L. A. O. - Tumores do coração. In: RAIA, A. A. & ZERBINI, E. J. eds. Clinica cirúrgica Alipio Corrêa Neto. São Paulo, Sarvier, 1988. p.
6 DEIN, J. R.; FRIST, W. H.; STINSON, E. B.; MILLER, C.; BALDWIN, J. C.; OYER, P. E.; JAMIESON, S.; MITCHELL, R. S.; SHYMWAY, N. E. - Primary cardiac neoplsms: early and late results of surgical treatment in 42 patients. J. Thorac. Cardiovasc. Surg, 93: 502-511, 1987.
7 EDLUND, S. & HOLMDAHL, K. - Primary tumor of the heart: report of a case. Acta Paediat, 46: 59-63, 1957.
8 ETCHES, P. C.; GRIBBIN, B.; GUANNING, A. J. - Echocardiographic diagnosis and successful removal of cardiac fibroma in a four-year-old child. Br. Heart J., 43: 360-362, 1980.
9 FREEDBERG, R. S.; KRONZON, I.; RUMANCIC, W. M.; LIEBESKIND, L. - The contribution of magnetic resonance imaging to the evaluation of intracardiac tumors diagnosed by echocardiography. Circulation, 77: 96-103, 1988.
10 GEHA, A. S.; WIEDMAN, W. H.; SOULE, E. H.; McGOON, D. C. - Intramural ventricular fibroma: successful removal in two cases and review of the literature. Circulation, 36: 427-440,
11 HARDIM, N. J.; WILSON, S. M.; GRAY, G. F.; GAY, W. A. - Experience with primary tumors of the heart: clinical and pathological study of seventeen cases. John Hopkins Med. J, 134: 141-155, 1974.
12 HEATH, D. - Pathology of cardiac tumors. Am. J. Cardiol, 21: 315-327, 1968.
13 HOEN, A. G. & ELLIS, E. J. - Intramural fibroma of the heart. Am J. Cardiol, 17: 579-584, 1966.
14 ISNER, J. M.; FAOCONE, M. W.; VIRMANI, R.; ROBERTS, W. C. - Cardiac sarcoma causing "ASH" and simulating coronary heart disease. Am. J. Med, 66: 1025-1030, 1979.
15 JAMIESON, S. W.; GAUDIANI, V. A.; EWITZ, B. A.; OYER, P. E.; STINSON, E. B.; SHUMWAY, N. E. - Operative treatment of an unresectable tumor of the left ventricle. J. Thorac. Cardiovasc. Surg, 81: 797-799, 1981.
16 LINCOLN, J. C. R.; TYNAM, M. G.; WATERSTON, D. J. - Successful excision of an endocardial fibroma of the left ventricle in a 10-month-old infant. J. Thorac. Cardiovasc. Surg, 56: 63-70, 1968.
17 LUSCHKA, H. - Ein fibroid im HERZ fleische. Wirchows Arch. Pathol. Anal, 8: 434, 1885.
18 NADAS, A. S. & ELLISON, R. C. - Cardiac tumors in infancy. Am. J. Cardiol, 2: 363-366, 1968.
19 PARKS, F. R.; ADAMS, F.; LONGMISE Jr., W. P. - Successful excision of a left ventricular hemartoma. Circulation, 26: 1316-1320, 1962.
20 PARMLEY, L. F.; SALLEY, R. K.; WILLIAMS, J. P.; HEAD, G. B. - The clinical spectrum of cardiac fibroma with diagnostic and surgical considerations noninvasive imaging enhances management. Ann. Thorac. Surg, 45: 455-465, 1988.
21 TURI, G. K.; ALBALA, A.; FENOGLIO Jr., J. J. - Cardiac fibromatosis: an ultrastructural study. Hum. Pathol, 2 (Supl.): 577-580, 1980.
22 VAN DER HAUWAERT, L. G.; CORBEEL, L.; MALDAGUE, P. - Fibroma of the right ventricle producing severe tricuspid stenosis. Circulation, 32: 451-456, 1965.
23 YABEK, S. M.; JONES, J. I.; GYEPES, M. T.; JARMAKANI, J. M. - Cardiac fibroma in a neonate presenting with severe congestive heart feilure. J. Pediatr, 91: 310-312, 1977.
24 ZERKOWSKI, H. R.; HENTRICH, F.; DOETSCH, N. W.; ROHM, N. - Partial replacement of the left ventricular wall for a large intramural fibroma. Pediatr. Cardiol, 6: 43-45, 1985.

Endereço para separatas:

Luís Alberto Dallan

Divisão Cirúrgica

Av. Dr. Enéas Carvalho de Aguiar, 44

05403 São Paulo, SP, Brasil

Datas de Publicação

Publicação nesta coleção
17 Fev 2011
Data do Fascículo
Dez 1989

Histórico

Recebido
30 Dez 1989

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1 ARCINIEGAS, E.; HAKINI, M.; FAROOKI, Z. Q.; TRUCCONE, N. J.; GREEN, E. W. - Primary cardiac tumors in children. J. Thorac. Cardiovasc. Surg, 79: 582-591, 1980.

[2] 2 BIANCANIELLO, T. M.; MEYER, R. A.; GAUM, W. E.; KAPLAN, S. - Primary benign intramural ventricular rumors in children: pre-and postoperative electrocardiographic, echocardiographic, and angiocardiographic evolution. Am. Heart J, 103: 852-857, 1982.

[3] 3 CABIN, H. S.; COSTELLO, R. M.; VASUDEVAN, G.; MARON, B. J.; ROBERTS, W. C. - Cardiac lymphome mimicking hypertrophic cardiomyopathy. Am. Heart J, 102: 466-468, 1981.

[4] 4 CHITWOOD, W. R. - Cardiac neoplasms: current diagnosis, pathology, and therapy. J. Cardiac. Surg, 3: 119-154, 1988.

[5] 5 DALLAN, L. A. O. - Tumores do coração. In: RAIA, A. A. & ZERBINI, E. J. eds. Clinica cirúrgica Alipio Corrêa Neto. São Paulo, Sarvier, 1988. p.

[6] 6 DEIN, J. R.; FRIST, W. H.; STINSON, E. B.; MILLER, C.; BALDWIN, J. C.; OYER, P. E.; JAMIESON, S.; MITCHELL, R. S.; SHYMWAY, N. E. - Primary cardiac neoplsms: early and late results of surgical treatment in 42 patients. J. Thorac. Cardiovasc. Surg, 93: 502-511, 1987.

[7] 7 EDLUND, S. & HOLMDAHL, K. - Primary tumor of the heart: report of a case. Acta Paediat, 46: 59-63, 1957.

[8] 8 ETCHES, P. C.; GRIBBIN, B.; GUANNING, A. J. - Echocardiographic diagnosis and successful removal of cardiac fibroma in a four-year-old child. Br. Heart J., 43: 360-362, 1980.

[9] 9 FREEDBERG, R. S.; KRONZON, I.; RUMANCIC, W. M.; LIEBESKIND, L. - The contribution of magnetic resonance imaging to the evaluation of intracardiac tumors diagnosed by echocardiography. Circulation, 77: 96-103, 1988.

[10] 10 GEHA, A. S.; WIEDMAN, W. H.; SOULE, E. H.; McGOON, D. C. - Intramural ventricular fibroma: successful removal in two cases and review of the literature. Circulation, 36: 427-440,

[11] 11 HARDIM, N. J.; WILSON, S. M.; GRAY, G. F.; GAY, W. A. - Experience with primary tumors of the heart: clinical and pathological study of seventeen cases. John Hopkins Med. J, 134: 141-155, 1974.

[12] 12 HEATH, D. - Pathology of cardiac tumors. Am. J. Cardiol, 21: 315-327, 1968.

[13] 13 HOEN, A. G. & ELLIS, E. J. - Intramural fibroma of the heart. Am J. Cardiol, 17: 579-584, 1966.

[14] 14 ISNER, J. M.; FAOCONE, M. W.; VIRMANI, R.; ROBERTS, W. C. - Cardiac sarcoma causing "ASH" and simulating coronary heart disease. Am. J. Med, 66: 1025-1030, 1979.

[15] 15 JAMIESON, S. W.; GAUDIANI, V. A.; EWITZ, B. A.; OYER, P. E.; STINSON, E. B.; SHUMWAY, N. E. - Operative treatment of an unresectable tumor of the left ventricle. J. Thorac. Cardiovasc. Surg, 81: 797-799, 1981.

[16] 16 LINCOLN, J. C. R.; TYNAM, M. G.; WATERSTON, D. J. - Successful excision of an endocardial fibroma of the left ventricle in a 10-month-old infant. J. Thorac. Cardiovasc. Surg, 56: 63-70, 1968.

[17] 17 LUSCHKA, H. - Ein fibroid im HERZ fleische. Wirchows Arch. Pathol. Anal, 8: 434, 1885.

[18] 18 NADAS, A. S. & ELLISON, R. C. - Cardiac tumors in infancy. Am. J. Cardiol, 2: 363-366, 1968.

[19] 19 PARKS, F. R.; ADAMS, F.; LONGMISE Jr., W. P. - Successful excision of a left ventricular hemartoma. Circulation, 26: 1316-1320, 1962.

[20] 20 PARMLEY, L. F.; SALLEY, R. K.; WILLIAMS, J. P.; HEAD, G. B. - The clinical spectrum of cardiac fibroma with diagnostic and surgical considerations noninvasive imaging enhances management. Ann. Thorac. Surg, 45: 455-465, 1988.

[21] 21 TURI, G. K.; ALBALA, A.; FENOGLIO Jr., J. J. - Cardiac fibromatosis: an ultrastructural study. Hum. Pathol, 2 (Supl.): 577-580, 1980.

[22] 22 VAN DER HAUWAERT, L. G.; CORBEEL, L.; MALDAGUE, P. - Fibroma of the right ventricle producing severe tricuspid stenosis. Circulation, 32: 451-456, 1965.

[23] 23 YABEK, S. M.; JONES, J. I.; GYEPES, M. T.; JARMAKANI, J. M. - Cardiac fibroma in a neonate presenting with severe congestive heart feilure. J. Pediatr, 91: 310-312, 1977.

[24] 24 ZERKOWSKI, H. R.; HENTRICH, F.; DOETSCH, N. W.; ROHM, N. - Partial replacement of the left ventricular wall for a large intramural fibroma. Pediatr. Cardiol, 6: 43-45, 1985.