Cardiac hemangiomas are extremely rare benign vascular tumors of the heart, with an incidence of less than 0.03% at autopsy [1]. Histologically, cardiac hemangiomas can be classified into three categories: capillary, cavernous, and arteriovenous hemangiomas [2]. Of these, cardiac cavernous hemangiomas are exceptionally rare, and seldom involving the left atrial and coronary artery. Surgical excision should be performed as early as possible after diagnosis [3]. To our knowledge, only 3 references of surgically treated left atrial roof cavernous hemangiomas have been reported [4,5,6]. We reported a cavernous hemangioma located in the left atrial roof and involving the left coronary artery.
Case presentation
An asymptomatic 56-year-old female was hospitalized because of a cardiac mass noted by a chest computed tomography (CT) scan during a physical examination. Preoperative transthoracic echocardiography (TTE) revealed an uneven hyperechoic mass, measuring 81 m × 38 mm, located in the left atrium. The mass attached to the interatrial septum adjacent to the mitral annulus but was not hampering blood flow of mitral valve. Preoperative coronary computed tomography angiography (CTA) showed a relatively low-intensity mass (78 mm × 42 mm) in the left atrial roof and extended to the posterior wall of the aortic root. Coronary CTA revealed no communicating branches between the hemangioma and coronary artery or coronary artery stenosis (Fig. 1). Thus, the surgery was performed via a median sternotomy under cardiopulmonary bypass (CPB). After the pericardium was incised, the tumor was found to cover the left atrial roof and extend to the posterior wall of the aortic root (Fig. 2). We successfully excised the tumor with low-frequency electrocautery from the left atrium to the aortic root without injury the coronary artery and the left atrial wall. Left atrium was opened to inspect the invasion status. Its endocardium was smooth and clear of invasion. After heart resuscitation, the patient weaned easily off bypass. On gross inspection, the tumor was a 7 cm × 4 cm × 3 cm, elastic, soft and reddish-brown mass (Fig. 3). Histological examination after hematoxylin-eosin staining demonstrated a tumor comprised multiple dilated vascular channels with endothelial cell lining (Fig. 4). Cells lining in the vessels stained positive with CD31, CD34(Fig. 5), Indicating their endothelial origin. Cytologic examination revealed the presence of numerous mesenchymal and inflammatory cells, and absence of malignant cells.
The patient was discharged 5 days after the operation with an uneventful recovery. Telephone following-up is conducted every 3 months after discharge, the patient claimed no obvious discomfort. TTE 6 months after surgery showed no relapse of the cavernous hemangioma.
