PMC7708872_01
Right Heart Masses on Echocardiography: (a) long axis parasternal view showing a large mass (arrow) adhered to the right side of the interventricular septum; (b) anteriorly angulated four chamber apical view showing the same mass (arrow); (c) four chamber apical view showing right chambers enlargement and thickening of the tricuspid subvalvar apparatus (arrow); (d) severe tricuspid regurgitation (arrow). LA: left atrium; LV: left ventricle; RA: right atrium; RV: right ventricle.
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A transthoracic echocardiography performed in the emergency room revealed a large mass located in the right ventricular cavity and apparently adhered to the interventricular septum, right ventricle (RV) enlargement, a probable thickening of the tricuspid sub valvar apparatus, severe tricuspid regurgitation, pulmonary systolic arterial pressure of 35 mmHg and normal left ventricle (LV) dimension and systolic function (Fig. 1).
Cardiac magnetic resonance imaging showing a large mass (*) and a smaller one (arrow) inside the RV. DA: descending aorta; LA: left atrium; LVOT: left ventricle outflow tract; PA: pulmonary artery; PE: pericardial effusion; RV: right ventricle.
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Moderate global systolic deficit (estimated ejection fraction of 39%) was reported, attributed to the RVOT obstruction (Fig. 2).
Surgical specimen consisting of 3 pink-tan rubbery masses. A: mass adhered to the tricuspid valve (valve tissue - arrow); B: mass attached to the interventricular septum; C: mass attached to the anterior face of the RVOT.
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Intraoperatively, a third small neoformation was identified heavily incorporated to the ventricular face of the anterior leaflet and to the chordae of the tricuspid valve (Fig. 3).
Four chamber apical view showing normal function tricuspid valve prosthesis and RV with systolic function preserved.
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Furthermore, the postoperative control transthoracic echocardiography showed the normal functioning tricuspid valve, without any obstruction of the RVOT and preserved systolic function of both ventricles (Fig. 4).