Ventricular Tumors Research Articles

A comprehensive approach to lateral ventricular tumor resection: techniques, technologies, and outcomes.

This study reviews lateral ventricular tumors (LVTs), which are rare brain lesions accounting for 0.64-3.5% of brain tumors, and the unique challenges they present due to their location and growth patterns. Once deemed inoperable, advancements in microneurosurgery, imaging, and tumor pathobiology have significantly improved treatment outcomes. This letter summarizes recent studies and key findings in the management of LVTs. Research by S.A. Maryashev et al. identified risk factors for early hemorrhagic complications following the surgical resection of lateral ventricular neoplasms, highlighting the significance of patient characteristics, tumor location, and surgical approach. The study found that factors such as gender, hydrocephalus, tumor blood flow, and Evans index correlate with a higher risk of hemorrhage, with the transcallosal approach having a greater risk compared to the transcortical approach. The utilization of navigation technologies, including fMRI, neuronavigation, and intraoperative brain mapping, has been shown to reduce surgical complications and enhance patient outcomes in the treatment of lateral ventricular meningiomas. Moreover, endoscopic and endoport-assisted endoscopic techniques have proven to be valuable in intraventricular tumor surgery, enabling minimally invasive procedures with better visualization and fewer complications. The integration of advanced surgical techniques, neuroimaging, and neurophysiological monitoring emphasizes the necessity of a multidisciplinary approach to optimize patient outcomes. To improve the study's validity and applicability, further research with larger sample sizes and advanced statistical analyses is needed. This letter advocates for the continued exploration of innovative surgical techniques and technologies to enhance the management of lateral ventricular tumors.

Comparative Analysis of Supratentorial Intraventricular Tumors in Adults and Pediatrics in a Developing Country: Clinicopathological Features, Surgical Management, and Outcomes.

Supratentorial intraventricular tumors, encompassing lateral and third ventricular tumors, are uncommon intracranial neoplasms, typically slow-growing and benign, manifesting symptoms only upon reaching a substantial size. This study aims to identify optimal surgical approaches, assess the prevalence and characteristics of these tumors, and evaluate postoperative outcomes among pediatric and adult age groups. A retrospective comparative study at a tertiary care hospital from January 2014 to June 2020 included 165 patients (68 pediatrics, 97 adults) meeting inclusion criteria for intraventricular tumor management. Data covered demographic factors, clinical history, neurological assessments, neuroimaging, surgical approaches, histopathological diagnoses, immunohistochemical features, adjuvant therapies, follow-up status, postoperative complications, and morbidity/mortality. Ventricular tumor incidence showed male preponderance in both adults (M:F = 1.2:1) and pediatrics (M:F = 3:1). Lateral ventricles were the most common location. Pediatric cases exhibited more frequent calcifications on computed tomography scans (35.6% vs. 29.5%). Grade II and III tumors were more prevalent in adults within the lateral ventricle (27.1 and 1.9%) compared with pediatrics (6.5 and 8.4%). The third ventricle predominantly featured benign lesions, with pediatric patients experiencing significantly longer hospital stays (16.12 ± 21.94 days vs. 9.58 ± 6.21 days) (p = 0.006). Adults and pediatric patients showed a significant difference in high-grade lateral ventricle tumors (p-value = 0.002*). Supratentorial ventricular tumors are relatively more prevalent in children than adults, presenting challenges due to size and bleeding risks. Surgical resection is the primary treatment, with a focus on the optimal approach for gross total excision to reduce recurrence risk.

Surgical techniques for treatment and prevention of entrapped temporal horn after resection of trigone ventricular tumors

Aim. To analyze the effectiveness of treatment and prevention of entrapped temporal horn (ETH) using various techniques.Materials and methods. The study included 14 patients who underwent treatment or surgical prevention of ETH of the lateral ventricle after surgical resection of tumors in the projection of the trigone of the lateral ventricle. In 3 cases, microsurgical ventriculocisternostomy was performed; in 3 cases, shunting surgeries for ETH treatment; in 8 cases, ETH stenting.Results. Tumor resection level, stenting effectiveness per presence/absence of hydrocephalus, and adequacy of the chosen ETH treatment and prevention methods were analyzed. In all 3 cases of ventriculocisternostomy, tumor resection was radical, stoma was strong, ETH opened, hydrocephalus was absent. In 3 patients with shunt implantation, radical resection was performed in 1 case; in 2 cases subtotal resection was achieved; shunt dysfunction due to tumor progression was observed in 1 patient during long‑term follow‑up. In 7 of 8 patients with cases of ventricular stent implantation for treatment/prevention of ETH, tumor resection was total; in 1 patient subtotal. Stenting performed in the postoperative period for treatment of hydrocephalus had positive clinical effect in 100 % of cases (non‑focal neurological symptoms, stasis in the fundus, speech disorders regressed). In stenting for hydrocephalus prevention, a positive effect was also observed (no increase in the size of the ventricular system, shunting surgeries in the postoperative period were not required). In the analyzed patient group (n = 14), de novo neurologic deficit did not develop, no cases of infectious complications and cerebrospinal fluid leak were observed, stent did not dysfunction.Conclusion. Intraoperative ventriculocisternostomy is a reliable physiological technique for ETH prevention. Stenting of the ventricular system is an accessible and effective technique for ETH prevention. Single‑step stenting after tumor resection allows to avoid this complication in the long‑term and is not associated with surgical complications of distal stenting. The use of stenting surgeries has its advantages and disadvantages which makes this method acceptable but not universal. Implantation of shunt in the long‑term period is the method of choice for ETH treatment.

The telovelar approach for fourth ventricular tumors in children: is removal of the posterior arch of C1 necessary?

PurposeVarious surgical nuances of the telovelar approach have been suggested. The necessity of removing the posterior arch of C1 to accomplish optimal tumor exposure is still debated. Therefore, we report on our experience and technical details of the fourth ventricular tumor resection in a modified prone position without systematic removal of the posterior arch of C1.MethodsA retrospective analysis of all pediatric patients, who underwent a fourth ventricular tumor resection in the modified prone position between 2012 and 2021, was performed.ResultsWe identified 40 patients with a median age of 6 years and a M:F ratio of 25:15. A telovelar approach was performed in all cases. In 39/40 patients, the posterior arch of C1 was not removed. In the remaining patient, the reason for removing C1 was tumor extension below the level of C2 with ventral extension. Gross or near total resection could be achieved in 34/39 patients, and subtotal resection in 5/39 patients. In none of the patients, a limited exposure, sight of view, or range of motion caused by the posterior arch of C1 was encountered, necessitating an unplanned removal of the posterior arch of C1. Importantly, in none of the cases, the surgeon had the impression of a limited sight of view to the most rostral parts of the fourth ventricle, which necessitated a vermian incision.ConclusionA telovelar approach without the removal of the posterior arch of C1 allows for an optimal exposure of the fourth ventricle provided that critical nuances in patient positioning are considered.

Successful Chemotherapy Treatment for a Tricuspid Valvular Stenosis Patient due to Right Ventricular Lymphoma.

This study presents a patient diagnosed with tricuspid valvular stenosis due to right ventricular lymphoma, who was treated successfully. A 66-year-old man with a history of worsening shortness of breath during activity for the last three weeks sought medical attention. The patient later experienced swelling in the extremities, fluid build-up around the lungs and abdominal fluid accumulation, with no reported chest pain, fever, or weight loss. An echocardiogram found a mass in the lateral wall near the tricuspid valve of the right ventricle, leading to moderate tricuspid stenosis. The cardiac magnetic resonance imaging (MRI) revealed a lumpy, poorly defined mass that invaded the heart muscle and displayed varied enhancement after contrast administration. Suspicion arose for a malignant tumour or metastatic lesion due to its features and contrast uptake capability. A percutaneous biopsy was carried out on the mass in the right ventricle to confirm the diagnosis. The pathology report indicated a diagnosis of non-Hodgkin's lymphoma. After being diagnosed, the patient underwent chemotherapy using the R-CHOP regimen. Over time the symptoms improved, and echocardiograms revealed a decrease in the size of the tumour. After undergoing six rounds of chemotherapy, a cardiac MRI four months later showed no signs of a tumour. After that, the patient resumed their regular activities. Right ventricular tumours are mostly malignant lesions and often have an inferior prognosis. Early diagnosis with imaging techniques and myocardial biopsy is necessary to deliver life-saving treatment quickly. Right ventricular tumours are mostly malignant lesions and often have an inferior prognosis.Early diagnosis with imaging techniques and myocardial biopsy is necessary to deliver life-saving treatment quickly.Right ventricular lymphoma is a sporadic tumour, but the prognosis is favourable if detected in time.

Microsurgical ventriculostomy of the third ventricle with access through a burrhole in the treatment of midly located deep-seated brain tumors

Currently, endoscopic third ventriculostomy and simultaneous biopsy of deep midline brain tumors are a generally accepted option in neurooncology. Nevertheless, effectiveness of this surgery and diagnostic accuracy of biopsy are not without drawbacks. An alternative to endoscopic surgery may be simultaneous microsurgical third ventriculostomy and biopsy of deep midline tumors. To evaluate effectiveness and safety of burr hole microsurgical third ventriculostomy in the treatment of deep midline brain tumors. We used transcortical (25 cases) and transcallosal (8 cases) approaches for microsurgical third ventriculostomy. Initially scheduled biopsy was performed in 19 cases, partial resection in 6 cases, subtotal resection in 4 cases and total resection in 4 cases. All patients underwent microsurgical third ventriculostomy. In 12 cases, stenting of stoma was performed in addition to ventriculostomy. Biopsy was informative in all cases. Postoperative follow-up period ranged from 3 to 44 months (mean 29 months). There was no postoperative hydrocephalus and need for shunting procedure. Burr hole microsurgery may be an alternative to endoscopic surgery for the treatment of pineal, periaqueductal and third ventricular tumors.

Endoscopic Cylinder Surgery for Ventricular Lesions.

Cylinder retractors have been developed to reduce the risk of brain retraction injury during surgery by dispersing retraction pressure on the brain. In recent years, various types of cylinder retractors have been developed and widely used in neurosurgery. The ventricles, being deep structures within the brain, present an effective area for cylinder retractor utilization. Endoscopy provides a bright, wide field of view in the deep surgical field, even through narrow corridors.This chapter introduces surgical techniques using an endoscope through a cylinder. Given the deep and complex shapes of the ventricles, preoperative planning is paramount. Two main surgical techniques are employed in endoscopic cylinder surgery. The wet-field technique involves the continuous irrigation of artificial cerebrospinal fluid (CSF) during the procedure, maintaining ventricle shape with natural water pressure, facilitating tumor border identification, and achieving spontaneous hemostasis. Conversely, the dry-field technique involves CSF drainage, providing a clear visual field even during hemorrhage encounters. In intraventricular surgery, both techniques are used and switched as needed.Specific approaches for lateral, third, and fourth ventricular tumors are discussed, considering their locations and surrounding anatomical structures. Detailed intraoperative findings and strategies for tumor removal and hemostasis are presented.Endoscopic cylinder surgery offers a versatile and minimally invasive option for intraventricular tumors, leading to improved surgical outcomes. Overall, this technique enhances surgical precision and patient outcomes in intraventricular tumor cases.

Left ventricular benign tumors commonly misdiagnosed as thrombus

Left ventricular benign tumors commonly misdiagnosed as thrombus

Application of endoport-assisted neuroendoscopic techniques in lateral ventricular tumor surgery.

The objective of this study was to investigate the clinical experience and therapeutic efficiency of Endoport-assisted neuroendoscopic surgery for resection of lateral ventricular tumors. The key points and application value of this surgical technique were additionally discussed. A retrospective analysis was conducted on the clinical and follow-up data of 16 patients who underwent endoport-assisted neuroendoscopic surgery for lateral ventricular tumors at the Department of Neurosurgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, between January 2018 and September 2020. The surgical procedures, complications and outcomes were analyzed. The study included a total of 16 patients (5 males and 11 females) with lateral ventricular tumors, with a mean age of 43.2 years (18-70 years old). The tumors were distributed as follows: 5 cases involved the body of the lateral ventricle, 3 involved the frontal horn and body, 3 involved the occipital horn, 2 involved the trigone, 2 involved the frontal horn, and 1 case involved the occipital horn and body. Perioperative complications were analyzed, revealing 1 case of intraoperative acute epidural hematoma intraoperative and 2 cases of postoperative obstructive hydrocephalus. All complications were promptly managed. Postoperative MRI revealed that 14 cases (88%) achieved total resection, while 2 cases (12%) achieved subtotal resection. During the follow-up of 6-38 months, no recurrence was observed. The patient diagnosed with glioblastoma died 16 months after surgery (GOS=1), while the remaining patients have successfully resumed to normal daily life with a GOS score of 5. In conclusion, endoport-assisted neuroendoscopic surgery proved to be a minimally invasive and effective technique for resecting lateral ventricular tumors, with acceptable complications. It effectively utilizes the benefits of close observation, comprehensive exposure, and reduced tissue damage. Therefore, endoport-assisted neuroendoscopic surgery is suitable for the resection of lateral ventricular tumors.

Case report: Intraventricular tumor removal using transcallosal approach and follow-up in three dogs

This case series describes the surgical removal of lateral ventricular tumors using a transcallosal approach, long-term follow-up, and magnetic resonance imaging (MRI) results of 3 dogs. Two tumors were benign choroid plexus tumors (CPT). One was a grade 2 astrocytoma. Complete tumor removal was achieved using the transcallosal approach. All dogs had ventriculomegaly which remained static or progressed during the follow-up period. All dogs had epileptic seizures before the surgical procedure which persisted despite tumor removal. One dog with CPT was alive after 3 years and 5 months and had minor focal seizures every 3–4 months. No other clinical signs were observed. The second dog with CPT was neurologically free for 17 months after the surgical procedure but died due to acute-onset therapy-resistant generalized epileptic seizures. The third dog with intraventricular astrocytoma experienced epileptic seizures 2 and 4 months after the surgical procedure. The second event was therapy-resistant which led to death.

Telovelar versus Transvermian Approach in Management of Patients with Fourth Ventricular Tumors

Background Approaching the fourth ventricle surgically is particularly challenging due to the limited working space provided by the important surrounding cerebrovascular structures. Its close relationship to the surrounding neural structures, including the brainstem and cerebellum, is the major limitation for surgical access. Various surgical routes to the fourth ventricular space will be described in the literature, including the conventional transvermian approach. Recent clinical and anatomical studies have suggested that the telovelar approach will maximize the extent of surgical exposure and working angle while minimizing operative morbidity. Objectives Our primary objective is to evaluate the efficacy and outcome of each approach in handling tumors within different parts of 4th ventricle. Our secondary objective is to analyze approach related complication and limitations of application to find best surgical option for those patients with posterior fossa lesions. Methods The following electronic databases will be searched from 2000 to 2019: PubMed, Google scholar, Cocharne database of systematic reviews, EMBASE and Science direct using Keywords ''Telovelar approach'', ''Transvermian approach'', ''fourth ventricular tumours'', ''Medullary velum''. Studies will be eligible if they contain the target Keywords in title or abstract, addressing our subject. Afterwards the full text of the article will be reviewed to exclude full texts not fulfilling the criteria or deviating from the initial impression taken from the title/abstract reviewing. References\ bibliography of the selected article will be sorted by discussion between study team (Student, Director and Codirectors). Results A total of 130 study were screened for eligibility, 6 studies were included in our systematic review for comparing the Telovelar and Transvermian approach in reaching posterior fossa lesions located within 4th ventricle regarding efficacy, clinical outcome and improvement, safety and complication. It was found that each approach has its own merits and demerits with nearly no difference between them regarding efficacy and safety, however slight superiority was linked to Telovelar approach in minimizing post-operative posterior fossa syndrome and Hydrocephalic changes. Conclusion we concluded that, Both transvermian -without sustained retraction- and telovelar approaches have no significant difference in safety, feasibility of total tumor excision, clinical outcome, postoperative complications and cerebellar mutism. The choice of either approach depends mainly on the surgeon's skills and preference, However the telovelar approach is generally preferred.

Rare Case of Hemorrhagic Atypical Choroid Plexus Papilloma of Fourth Ventricle in Adult: A Diagnostic Dilemma

Choroid plexus papillomas are highly vascular tumors, and such tumors causing subarachnoid hemorrhage have been reported in literature. Similarly, few articles have reported atypical fourth ventricular choroid plexus tumors in adults. However, such an atypical tumor presenting with grossly hemorrhagic transformation without any acute symptoms could not be found in the literature.

Effect comparison of neuroendoscopy versus microsurgery in the treatment of lateral ventricular tumors.

We sought to reveal the clinical characteristics of lateral ventricle tumors and to evaluate the superior surgical procedure available. There involved a total of of 49 adult patients harboring lateral ventricle tumors in neurosurgery department of our hospital from January 2016 to March 2022. The patients enrolled were retrospectively analyzed, so are their clinical manifestations, pathological characteristics and surgical strategies. The patients were allocated into neuroendoscope group (11 cases) and microsurgery group (38 cases) according to the operation method. The two groups underwent a detailed evaluation of operation effectiveness and safety profile (operation time, intraoperative bleeding, surgical resection rate, postoperative complications) and economic indicators (postoperative hospital stay, hospital costs). The neuroendoscope group demonstrated a markedly shorter operation time than the microsurgery group (p<0.05), with the amount of bleeding significantly less than the microsurgery group (p<0.01). However, there was no significant difference in the resection rate and postoperative complications between the two groups (p>0.05). Significant difference was found in the economic indicators (postoperative hospital stay and hospital costs) of the patients in the neuroendoscope group (p<0.05). Surgery intervention is regarded as the core treatment option for lateral ventricle tumors. Both microsurgery and neuroendoscopy are effective with safety profile. In the selected lateral ventricle tumor surgery, the application of neuroendoscopic surgery showed promising results, in terms of less intraoperative bleeding, and shorter operation time, postoperative hospital stays, and hospital costs. The selection of surgical approach and methods for lateral ventricle tumors is principally depended on the experience of neurosurgeon concerning the surgical approach and related neuroanatomy.

Surgical treatment of rare benign right ventricular tumors in infants: two case reports

Objective: To describe rare clinical and morphological forms of right ventricular neoplasms (mesenchymal hamartoma, rhabdomyoma) in infants which required surgical treatment in infancy.Methods: We performed 2 radical operations to remove right ventricular neoplasms: neonatal mesenchymal hamartoma and infantile rhabdomyoma.Results: We confirmed the effectiveness of surgery for rhabdomyoma and mesenchymal hamartoma in infants based on an 11-year postoperative follow-up period. We followed a necessary search strategy to detect tuberous sclerosis complex often associated with rhabdomyoma.Conclusion: Surgical treatment of rare right ventricular neoplasms in infants demonstrated favorable long-term results. Received 29 December 2022. Revised 22 February 2023. Accepted 27 March 2023. Informed consent: The patients' mothers informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsLiterature review: E.A. Enin, A.V. MishinDrafting the article: A.V. MishinCritical revision of the article: K.N. Kuatbekov, E.A. Enin, A.L. Egizekov, A.A. SarsembayevaSurgical treatment: K.N. Kuatbekov, A.V. MishinFinal approval of the version to be published: K.N. Kuatbekov, E.A. Enin, A.L. Egizekov, A.V. Mishin, A.A. Sarsembayeva

A peculiar case of pure intraventricular glioblastoma

Glioblastoma (formerly named glioblastoma multiforme) is the most common primary central nervous system tumor, representing 45% of all cases and 15% of all intracranial neoplasms [1]. Its typical radiologic findings and localization make it often a lesion easy to diagnose. In MRI it usually appears as an irregularly shaped cystic lesion with ring contrast enhancement in T1-weighted images, localized in subcortical white matter and deep gray matter nuclei of the cerebral hemispheres. It involves more frequently the frontotemporal region followed by parietal lobes [1]. Few articles in literature described cases of intraventricular glioblastomas, defining those as secondary ventricular tumors because of their probable origin primarily from cerebral tissue with consequent transependymal development [2, 3]. Atypical presentations of these tumors make it more difficult to clearly differentiate them from other lesions more commonly located in the ventricular system. We describe a case with a unique radiological presentation: an intraventricular glioblastoma lying entirely within the ventricular walls, involving all the ventricular system, without mass effect or nodular parenchymal lesions.

Endoscopic endonasal approach to remove pediatric intraventricular tumors of the third ventricle.

Pediatric intraventricular tumors of the third ventricle are among the most difficult-to-treat brain tumors. Recently, endonasal endoscopic surgery for suprasellar, third ventricle, and median clivus lesions has become the common procedure, and its indications are expanding to pediatric cases. We describe our strategy for endonasal endoscopic surgery for pediatric third ventricle tumors. We report on surgical anatomies and our surgical procedures in detail, including case presentations. Endoscopic endonasal surgery has the advantage of providing a wider view of the tumor site, hypothalamus, optic chiasm, and other critical structures. Good indications for the endoscopic endonasal approach for intra-third ventricular tumors are those arising from the floor of the third ventricle. In particular, craniopharyngioma, a typical pediatric suprasellar tumor, sometimes extends into the third ventricle, causing great operative difficulty. However, aggressive removal for long-term control while preserving memory and visual function is important. We perform surgery with a strategy of radically removing tumors without causing damage to visual or brain function, and we adopt the "4-hands technique by two neurosurgeons" in full endoscopic surgery to remove tumors safely and aggressively. We describe our strategy for endonasal endoscopic surgery for pediatric third ventricle tumors, especially those extending from the suprasellar region into the third ventricle, and present a representative case.

Third Ventricular Subependymomas: Clinical Features and Outcomes Over Two Decades

Subependymomas are uncommon, benign slow-growing neoplasms of the central nervous system preferentially arising within the fourth and lateral ventricles. Third ventricle involvement has been described rarely. The aim of this study is to provide the first systematic review of third ventricular subependymomas (TVSE) by analyzing all reported cases over 2 decades and describing a case example. MEDLINE and Embase databases were searched for the 20 years ending January 1, 2022, using relevant MeSH and non-MeSH terms, including "subependymoma" and "third ventricle." Methodology followed PRISMA guidelines. Of 804 identified studies, 131 met inclusion eligibility. The literature yielded 17 patients with TVSE plus our example (18 total). Of these patients, 83% (15/18) presented in adulthood (average age, 42 ± 19 years), of whom 73% were women. The pediatric cohort age was 5 ± 1 years, 67% (4/6) of whom were girls. The most common presenting symptom in both cohorts was headache (80%), followed by memory disturbances and vomitus. In adults, symptomatic tumors were approached by open craniotomy in all but 1 case, most using a transcallosal approach. Gross total resection was obtained in 73%. A ventriculoperitoneal shunt was inserted in 2/15 adult and 4/6 pediatric patients. Overall, both cohorts showed symptomatic improvement without disease recurrence. One patient died perioperatively. Subependymomas should be considered in the differential diagnosis of third ventricular tumors. The clinical presentation of TVSE mainly parallels hydrocephalus symptoms and, hence, awareness is of vital importance for timely treatment. The surgical goal should be gross total resection, which can be curative and offers greatest clinical improvement across the population.

Huge right ventricular myxoma in a 15-year-old female patient: a case report and literature review

BackgroundMyxomas represent about 5–10% of primary cardiac tumors in children, and only about 2.5–4% of cardiac myxomas originate from ventricular chambers. Symptoms and signs of right ventricular tumors depend mainly on the size and the site of the tumor and its effect on the inflow and outflow of the blood.Case presentationA 15-year-old female patient presented with syncope on exertion and symptoms and signs of congestive heart failure. She had a history of dyspnea and palpitation on exertion for 2 years before admission. Echocardiography and cardiac magnetic resonance imaging (MRI) diagnose a huge right ventricular mobile mass (9 × 4.6 × 3.7 cm) prolapsing during systole into the main pulmonary artery and severe tricuspid regurgitation. The mass showed no contrast enhancement in early dynamic and delayed gadolinium images, suggestive of a thrombus. The mass was safely excised and tricuspid annuloplasty repair was done using right atriotomy and vertical right ventriculotomy approaches. The patient was discharged in a well condition on postoperative day 6. Pathologically, the mass was confirmed as cardiac myxoma with old extensive hemorrhage inside.ConclusionsEarly echocardiography is essential for patients complaining of unexplained cardiac symptoms for early diagnosis and management of rare cases. Multimodality imaging is needed for the diagnosis and planning of the surgical procedure of right ventricular masses. Hemorrhage inside myxoma may lead to no contrast enhancement of the tumor.

Calcified False Tendon Linked to Sudden Cardiac Death in a Young Adult: An Autopsy-based Case Report

Left Ventricular False Tendons (LVFTs) are cord-like structures that traverse the cavity of the left ventricle, connecting the left ventricular free wall or papillary muscle and the ventricular septum without attachment to the mitral valve leaflets. They are incidentally found in autopsy heart specimens. False tendons are generally benign anatomic variants and can be associated with functional murmurs and electrocardiographic abnormalities. False tendons can also be a cause of ventricular arrhythmias. Two-dimensional echocardiography serves as a useful imaging modality in detecting false tendons. They should be differentiated from other entities such as thickened ventricular trabeculations, an accessory anterior mitral leaflet, thrombus, vegetation, and ventricular masses or tumours. Most LVFTs are transverse and are located in the apex. They are found to arise from the inner trabeculated layer of the myocardium. The exact prevalence of LVFTs remains unclear. Present report is a case of postmortem findings in the heart of a 34-year-old male who experienced a sudden collapse while walking after lunch. On gross examination, the left ventricular wall and the lower part of the interventricular septum showed focal grey-white areas. A well-defined, grey-white, hard polypoidal lesion was noted in the left ventricle near the apex, attached to the papillary muscles. The left anterior descending artery showed early atherosclerotic changes. LVFT was diagnosed, which could have been the reason for the arrhythmia. Hence, the evaluation of cardiac murmurs and arrhythmias by two-dimensional echocardiography and cardiac Magnetic Resonance Imaging (MRI) serves as helpful parameters in detecting LVFTs.

Abstract 9262: The Clinical and Electrophysiologic Manifestations of Cardiac Tumors: A Single-Center Retrospective Study

Introduction: Cardiac tumors are rare and their effect on the cardiac conduction system is not well-described. Currently there is no recommendation for routine arrhythmia screening in this population. This study aimed to characterize the clinical presentation and electrophysiologic manifestations of patients with cardiac tumors. Methods: A radiologic database from a four-hospital health system was queried to identify patients with a cardiac tumor diagnosed on CMR from 2003-2021. The electronic health record, ECGs, arrhythmia monitors, echocardiograms and CMRs were reviewed for each patient. Results: Forty-nine patients were identified with intra-cardiac or pericardial tumors. The cohort had a mean age of 57.3 ±14.6 years old and was 53% female. Cardiovascular risk factors were prevalent: HTN (59%), HLD (43%), DM (26%), CAD (20%). Common presenting symptoms were SOB (30.6%), palpitations (24.5%) and chest pain (20.4%); many patients had no overt cardiac symptom (42.9%). By CMR, tumors were classified as pericardial (44.9%) vs myocardial (55.1%), primary tumor (57.1%) vs secondary tumor (42.9%) and located nearest the atrium (24.5%), ventricle (55.1%) or both (14.3%). Twenty-three patients (47%) had tumors that were labeled as malignant, with the most common diagnoses being diffuse large B-cell lymphoma (DLBCL, 10.2%), non-small cell lung cancer (8.2%) and melanoma (6.1%). Non-trivial pericardial effusions were common (24.5%), with one case complicated by tamponade. Seven patients (14.2%) were documented to have cardiac arrhythmias including one patient with sudden arrhythmic death (SAD). Neither pericardial effusion (OR 3.7, CI 0.5-29.6) nor atrial tumor location (OR 2.8, CI 0.4-21.8) was predictive of atrial fibrillation or SVT. Ventricular arrhythmias were observed in patients with ventricular tumors (11.8%), but not atrial tumors (0%). Sustained VT was found in two patients with invasive DLBCL. Conclusion: Cardiac tumors are associated with frequent cardiac symptoms, pericardial effusions and cardiac arrhythmia. Sustained VT was documented in two patients with DLBCL in the ventricle, one of whom experienced SAD. Prospective studies employing long-term rhythm monitoring may be warranted to inform the need for arrhythmia screening.