Images in Cardiothoracic Medicine and Surgery

Cavernous hemangioma of the left atrial appendage

Asian Cardiovascular & Thoracic Annals 2015, Vol. 23(8) 1005–1006 ß The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492314533973 aan.sagepub.com

Ahmad K Darwazah1 and Rami Zagha2

Figure 1. Preoperative coronary angiography showing proximal lesions in the LAD, diagonal, and circumflex coronary arteries. A small rounded 1  1-cm aneurysm can be seen.

Figure 3. Histopathological examination showing an intramuscular lesion formed of anastomosing vascular spaces. Hematoxylin and eosin stain, original magnification 1000.

Figure 2. (a) Intraoperatively, a well-circumscribed, reddish, and rounded 1  1-cm mass was seen originating from the medial surface of the left atrial appendage. It had a wide base with no stalk. (b) Complete excision of the mass with the surrounding tissue of the left atrial appendage.

A 62-year-old lady was urgently transferred due to newly discovered coronary artery disease after cardiac arrest induced by spinal anaesthesia. Her medical history included hypertension, severe osteoporosis, and fracture of the shaft of the right tibia. Four days before admission, she fractured the neck of her right femur and was referred for dynamic hip screw fixation. During spinal anesthesia, she had a cardiac arrest and was successfully resuscitated. Coronary angiography revealed lesions in the left anterior descending, diagonal, and circumflex coronary arteries associated with a small aneurysm (Figure 1); the right coronary was

normal. Urgent myocardial revascularization was performed using an off-pump technique to graft the affected arteries using left internal mammary artery and saphenous vein grafts, followed by fixation of the 1 2

Department of Cardiac Surgery, Ramallah Hospital, Israel Department of Pathology, Ramallah Hospital, Israel

Corresponding author: Ahmad K Darwazah, PhD, FRCS, Department of Cardiac Surgery, Ramallah and Makassed Hospital, Mount of Olives, Jerusalem, Israel 91194. Email: [email protected]

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Asian Cardiovascular & Thoracic Annals 23(8)

intertrochanteric fracture. Intraoperatively, a mass was found originating from the left atrial appendage (Figure 2a). Complete excision was performed (Figure 2b). Histopathological examination was compatible with a cavernous hemangioma (Figure 3). Hemangiomas are rare benign tumors of the heart with an incidence of 2% of all primary tumors. They commonly affect the left ventricle, right atrium, and right ventricle. Hemangioma arising from the left atrium is rare; only a few cases have been reported.

Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflict of interest statement None declared.

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Cavernous hemangioma of the left atrial appendage.

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