<div>A rare case of cardiac mass complicated with chronic thromboembolic
pulmonary hypertension</div><div>Running title: cardiac mass with pulmonary embolism</div><div>Xiaoli Qin MD<sup>1</sup>, Weitao Liang PhD<sup>1</sup>,
and Zhong Wu PhD<sup>1</sup></div><div>Co-first-author: Weitao Liang</div><div><sup>1</sup>Department of Cardiovascular Surgery, West China
Hospital, Sichuan University, Chengdu,</div><div>Sichuan, P.R.China.</div><div>Corresponding author: Zhong Wu</div><div>Postal Address: Department of Cardiovascular Surgery, West China
Hospital, Sichuan</div><div>University; Chengdu, Sichuan, P.R. China, 610000;</div><div>Tel.: +86-028-85422897; Fax: +86-028-85422897; E-mail:
wuzhong_71@163.com</div><div>Abstract</div><div>Cardiac mass is very rare. We reported a case of cardiac mass
complicated with chronic thromboembolic pulmonary hypertension.</div><div>Keywords: cardiac mass, intracardiac thrombosis, pulmonary embolism</div><div><div>A 41-year-old man presented with an eight-month history of chest
tightness and dyspnea. Transthoracic echocardiography (TTE) revealed a
4*2cm mass attached to the tricuspid valve chordae and massive tricuspid
regurgitation (Figures 1A-1C). The systolic tricuspid pressure gradient
was 111mmHg. Pulmonary computed tomography angiography demonstrated a
filling defect located in the right ventricle, left and right pulmonary
artery, and their distal parts (Figures 1D and 1E). The laboratory test
and lower extremity venous ultrasound revealed no abnormalities.


The patient received the surgery and the intraoperative transesophageal
echocardiography (TEE) showed the mass was attached to the tricuspid
chordae tendineae (Figure 1F). After median sternotomy, cardiopulmonary
bypass, and right atriotomy, an irregular-shaped mass was discovered and
its pedicle was attached to the chordae tendineae (Figure 1G). We
excised the mass and pulmonary embolism completely and performed
pulmonary endarterectomy (Figures 1H and 1I). The postoperative period
was uneventful. The histopathological examination of the mass revealed
fibrous exudates and necrosis with focal calcification. The study was
approved by our Institutional Review Board and oral informed consent was
obtained from patient.


There was no tumorigenesis and it was more like an organized thrombus.
However, in our case, there was a pedicle of the mass attached to the
chordae tendineae. Cardiac mass in Behçet’s disease was reported and
pathological examination was similar to our case. But there were no
other positive symptoms of Behçet’s disease in our case.


References</div></div><ol><li>Yue C, Li J, Li M, Zhang F, Zhao D, Cui Q. Cardiac mass in Behçet’s
disease. Clin Exp Rheumatol. 2012;30(3 Suppl 72):S27-S31.</li><li>Mogulkoc N, Burgess MI, Bishop PW. Intracardiac thrombus in Behçet’s
disease: a systematic review. Chest. 2000;118(2):479-487.
doi:10.1378/chest.118.2.479.</li></ol><div><div>Figure 1 A-C, Transthoracic echocardiography shows a 4*2cm mass attached
to the tricuspid valve chordae and massive tricuspid regurgitation; D
and E, Pulmonary computed tomography angiography demonstrates a filling
defect located in the right ventricle, left and right pulmonary artery,
and their distal parts; F, Transesophageal echocardiography shows the
mass attached to the tricuspid chordae tendineae; G-I, Removal of the
mass and pulmonary embolism. LA, left atrium; LV, left ventricle; RA,
right atrium; RV, right ventricle</div></div>