An eight-month-old Chinese baby boy was admitted with a heart murmur suggestive of VSD. Echocardiogram revealed VSD and pulmonary hypertension (PH), the tumor was not detected until the operation. The patient subsequently underwent surgery under cardiopulmonary bypass (CPB). During the operation, the patient’s pulmonary artery was noticeably dilated, and a perimembranous VSD approximately 16 mm in diameter was revealed. Further surgical exploration discovered a firm 4 cm × 3.5 cm × 3 cm mass with unclear-edges under the junction of the left anterior descending (LAD) artery and the left circumflex (LCX) artery (Figure 1a). The mass was supplied by a large branch originating from LCX, and was adherent to surrounding tissues. Despite the mass being asymptomatic, there were concerns for the continued growth causing coronary artery compression and left ventricular cavity obstruction. These concerns were the reason for tumor resection at the time of VSD closure.
The VSD was repaired with a teflon patch. We opened the epicardium between LAD and LCX to expose the tumor and separate it from cardiac tissues, staying well away from the coronary arteries. We finally completely excised it from the left ventricle successfully (Figure 1b, c, d). Deciding on how to reconstruct the left ventricle was then considered. A patch repair may result in ventricular aneurysm which can lead to dyssynchronous contractility and subsequent decrease in cardiac function. The left ventricle was enlarged due to the volume overload on the left ventricle caused from the left to right shunt created by the VSD. As a result the myocardial tissue could be reapproximated easily to close the left ventricular wall defect. The patient was separated from CPB without any incidents. There was good left ventricular function with no compromise of the LAD and LCX (Figure 2). The patient was discharged on post-operative day 9 and remains asymptomatic on last follow-up.