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(Circulation. 2004;109:e300-e301.)
© 2004 American Heart Association, Inc.

Images in Cardiovascular Medicine

Left Ventricular Mass After Treatment With Chemotherapic Drugs

Vladimiro Vida, MD; Roberta Biffanti, MD; Gaetano Thiene, MD; Giovanni Stellin, MD; Ornella Milanesi, MD; Cristina Basso, MD, PhD

From the Institute of Paediatric Cardiac Surgery (V.V., G.S.), Paediatrics (R.B., C.B.) and Pathological Anatomy (G.T., O.M.), University of Padua Medical School, Padua, Italy.

Correspondence to Cristina Basso, MD, PhD, Institute of Pathological Anatomy, University of Padua Medical School, Via A. Gabelli, 61–35121 Padova, Italy. E-mail cristina.basso{at}unipd.it

A 23-year-old man with acute myeloid leukemia had been treated with chemotherapic agents and an autologous stem cell transplant at the age of 11 and had received a transplant of matched unrelated donor stem cells at the age of 22 for myelodysplastic syndrome. During a recent hospitalization for lung impairment, chest x-ray, computed tomography scan, and sputum cultures were suggestive of fungal infection with Aspergillus pneumoniae, and the patient was treated with Amphotericin B (GILEAD Sciences) and Caspofungin (Merck-Sharpe&Dohme Ltd) for 1 month. Three months after discharge, he underwent cardiac evaluation because of systemic hypertension. Two-dimensional echocardiography showed an oval (1.2x1.4 cm) floating mass in the left ventricular outflow tract near the aortic valve (Figure 1A and 1B). With the aid of cardiopulmonary bypass, cardioplegic arrest, and transverse aortic incision, the mass was excised from its base on the ventricular septum, 3 centimeters below the commissure between the right and left aortic cusps. The mass (Figure 2A) was whitish, friable, and oval shaped with a rough surface. Histologically, it consisted of characteristic branching septate hyphae enmeshed within fibrinous material (Figure 2B). With a diagnosis of left ventricular aspergilloma, the patient was treated with Voriconazole (Pfizer) for 7 weeks. No echocardiographic evidence of recurrence was present at the 4 months’ follow-up.

View larger version (89K): [in this window] [in a new window]   Figure 1. Two-dimensional echocardiography. Long axis view shows a solid floating mass 1.2x1.4 cm in size attached to the ventricular septum. A, diastole; B, systole. A indicates aspergilloma; AO, aorta, LA, left atrium, and LV, left ventricle.

View larger version (107K): [in this window] [in a new window]   Figure 2. A, Gross examination of the resected left ventricular mass. Note the irregular, rough surface and the implantation pedicle (arrow). B, Histologic section demonstrating abundant branching,septate hyphae enmeshed in a fibrinous background (PAS stain).

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

Related Article:

June 1, 2004: Notice of Editorial Office Transition

James T. Willerson
Circulation 2004 109: 2475. [Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Vida, V. Articles by Basso, C. Search for Related Content PubMed PubMed Citation Articles by Vida, V. Articles by Basso, C. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Related Collections Structure Echocardiography CV surgery: other Related Article