PMC8517140_01
(A,B) Transesophageal echocardiography showed the cardiac mass (15 x 14 mm) located in right ventricle, attached to the interventricular septum abutting the apex. RV, right ventricle; IVS, interventricular septum; LV, left ventricle.
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F1
Transesophageal echocardiography showed the cardiac mass (15 x 14 mm) located in right ventricle, attached to the interventricular septum (IVS) abutting the apex (Figure 1; Supplementary Video 1). TTE (Supplementary Figure 1).
(A,B) Magnetic resonance imaging demonstrated that a well-circumscribed homogenous nodule, measuring 16 x 13 mm, with medium signal intensity on T1-weighted images and medium signal intensity on T2- weighted images in the right ventricle, located adjacent to the IVS, was revealed uniform moderate enhancement for the first perfusion scan and uniform significantly delayed enhancement subsequently. RV, right ventricle; IVS, interventricular septum; LV, left ventricle.
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F2
A well-circumscribed homogenous "shadow," representing a nodule measuring 16 x 13 mm, with equal T1- and T2-weighted signal intensity in the right ventricle, located adjacent to the IVS, was revealed using moderate enhancement for the first perfusion scan and delayed myocardial enhancement MRI subsequently (Figure 2).
(A) The mass located in the right ventricle and was attached to the interventricular septum (white arrow). (B) The mass were removed completely and the IVS was intact without perforation (black arrow). RA, right atrium; RV, right ventricle; IVS, interventricular septum; SCTV, septal cusp of tricuspid valve; PM, papillary muscles.
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F3
Upon cardiac arrest, the right atrium was opened, and it was confirmed that the semispherical mass, with soft texture and broad base, originated from the IVS (Figure 3A). Because no significant boundary was detected preoperatively, the mass along with a small portion of IVS was resected (Figure 3B).
(A) Histopathology revealed that there are a lot of branches of vessels, thick-walled arteries (red arrow) and thin-walled veins (blue arrow), which was identified as cardiac arteriovenous malformation. (B) Histopathology showed the anomalous arteries with thick wall are composed of smooth muscle (blue arrow).
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F4
The histopathological examination revealed that the tumor was a cardiac AVM (Figures 4A,B). The patient's postoperative course was uneventful.