This site is not optimized for Internet Explorer 8 (or older).

Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.

Resection of Left Ventricular Rhabdomyoma in a Neonate

Wednesday, April 20, 2022

Said SM, Marey G. Resection of Left Ventricular Rhabdomyoma in a Neonate. April 2022. doi:10.25373/ctsnet.19617153 

This video features a one-day-old, 3kg neonate with a prenatal diagnosis of a cardiac mass. The postnatal transthoracic echocardiogram shows a large left ventricular mass occupying the majority of the left ventricular cavity and extending into the left ventricular outflow tract (LVOT). Other small masses also appear to be in the interventricular septum and on its right side. This suggests cardiac rhabdomyoma. A cardiac magnetic resonance imaging (MRI) confirms the findings. A brain MRI then shows features suggestive of tuberous sclerosis. Because of the large size of the mass and the presence of a gradient across the LVOT, the decision is made to proceed with resection. 

Through a median sternotomy, the thymus gland is resected and the ductus arteriosus is ligated. A cardiopulmonary bypass is initiated via aortic and bicaval cannulation. Then, after antegrade cardioplegic arrest, the apex of the left ventricle is delivered out of the pericardial cavity. Stay sutures with pledgeted 5-0 polypropylene sutures are placed at the apex of the left ventricle to assist with retraction. An apical left ventriculotomy is then created away from the location of the left anterior descending coronary artery. After this, the mass is clearly visualized.  

Using a combination of sharp dissection with Potts scissors and blunt peeling of the mass, the tumor is enucleated from the left ventricular cavity. Next, the integrity of the mitral valve, its subvalvular apparatus, and the aortic valve are checked. The left ventricular apical incision is then closed in two-layer fashion. The heart is then de-aired, and the aortic cross-clamp is removed. One thing of note, the atrial level shunt is closed subtotally.  

The patient is then weaned off cardiopulmonary bypass without difficulty after transesophageal echocardiogram confirms successful surgical result. The aortic cross-clamp and the cardiopulmonary bypass times are 99 and 131 minutes respectively. The patient is then extubated on the first postoperative day, and the remaining postoperative course was overall uneventful. 

A predischarge echocardiogram shows competent aortic and mitral valves as well as a mild decrease in the left ventricular function. The patient is therefore placed on load-reducing agents. She is discharged seventeen days later and does well during her follow-up. 


  1. Ugurlucan M, Oztas DM, Aygun E, Aliyev B, Altay AY, Ozluk Y, Omeroglu RE, Alpagut U. Giant Rhabdomyoma Requiring Emergency Resection Early After Birth. Ann Thorac Surg. 2019 Jan;107(1):e65
  2. Yuan SM. Fetal cardiac tumors: clinical features, management and prognosis. J Perinat Med. 2018 Feb 23;46(2):115-121
  3. Jordan CP, Costello JP, Endicott KM, Reyes C, Hougen TJ, Cummings SD, Nath DS. Intracardiac tumor causing left-ventricular outflow-tract obstruction in a newborn. J Saudi Heart Assoc. 2016 Jul;28(3):170-2


The information and views presented on represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.


Excellent demonstration, congratulations,always challenging. whether ventriculotomy could have been avoided.?Transaortic approach would have avoided scar in normal LV?. We recently removed LV clot in 24 yr old male patient transaortically,completion was checked transmitrally . Patient presented to us with lower limb ischemia, femoral embolectomy and LV clot removal was done.It was normal LV with good function and thickness, no comorbidity and habits except post covid. Avoided ventriculotomy patient did well. We can use fibre optic light source placed transmitrally, which will improve visualisation in adult patients.
Thank you for your comments. There is no way you can removed such a large mass in that size neonate through any route but the apex of the left ventricle. Transaortic approach and transmitral are only feasible for older children (depending on the size of the aortic annulus) and adults. The case you described occurred in a 24 year old patient and this is a whole different entity but I agree if we can avoid the ventriculotomy incision, that would be better.

Add comment

Log in or register to post comments