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(Circulation. 2003;107:1066.)
© 2003 American Heart Association, Inc.

Images in Cardiovascular Medicine

Left Ventricular Outflow Tract Obstruction Secondary to a Rhabdomyoma

John M. Costello, MD; Dolores A. Vitullo, MD; Peng Yan, RDCS; Carl L. Backer, MD; Constantine Mavroudis, MD

From the Divisions of Cardiology (J.M.C., D.A.V., P.Y.), Critical Care Medicine (J.M.C.), and Cardiovascular-Thoracic Surgery (C.L.B., C.M.), Children’s Memorial Hospital, The Feinberg School of Medicine at Northwestern University, Chicago, Ill.

Correspondence to Dolores A. Vitullo, MD, Division of Pediatric Cardiology, Children’s Memorial Hospital, 2300 Children’s Plaza, #21, Chicago, IL 60614-3394. E-mail dvitullo@childrensmemorial.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A1-day-old infant was noted to have a grade II/VI systolic ejection murmur at the base of the heart. An echocardiogram was obtained, which revealed a pedunculated, mobile mass in the left ventricular outflow tract, affixed to the interventricular septum just below the aortic valve (Figures 1 and 2). A 37-mm Hg peak Doppler gradient was detected between the left ventricle and ascending aorta. The patient was thought to be at risk for embolic events or sudden death. On the fifth day of life, the mass was resected through transaortic exposure using cardiopulmonary bypass and cardioplegic arrest (Figure 3). Histological examination showed the tumor to be a rhabdomyoma. The postoperative course was unremarkable, and a follow-up echocardiogram revealed no residual tumor or aortic valve dysfunction.

View larger version (85K): [in this window] [in a new window]   Figure 1. Echocardiographic parasternal short-axis view showing a tumor in the left ventricular outflow tract. The tumor nearly occludes the aortic valve annulus. Note the proximity of the tumor to the ostium of the right coronary artery. LA indicates left atrium; RA, right atrium; RCA, right coronary artery; and RV, right ventricle.

View larger version (105K): [in this window] [in a new window]   Figure 3. Intraoperative photograph taken from the anesthesiologist’s perspective. The tumor is visualized through the transected ascending aorta before resection. Asc Ao indicates ascending aorta.

View larger version (85K): [in this window] [in a new window]   Figure 2. Echocardiographic apical 4-chamber view during ventricular systole demonstrating the tumor in the left ventricular outflow tract. Ao indicates aorta; LA, left atrium; LV, left ventricle; and RV, right ventricle.

Although rhabdomyomas are the most common primary cardiac tumors in children, this case is . . . [Full Text of this Article]