CARDIAC FIBROMA PRESENTING WITH SYNCOPE

C. Cicero, N. Carano, A. Agnetti, B.Tchana, V. Allegri, A. Saracino, L.Zavota, C. Cavalli, P.L. Festa*, U. Squarcia.
Cardiologia Pediatrica - Dip. dell'Età Evolutiva - Univ. di Parma
*Istituto di Fisiologia Clinica-CNR Ospedale G Pasquinucci - Massa

Primary cardiac tumors are very uncommon in paediatrics (0,0017-0,28%) and their clinical features are strictly related to location, size and mobility.
Approximately 75% of such tumors are benign and 25% are malignant.
Cardiac fibroma are histologically benign but potentially lethal because of their location: most commonly they involve the ventricles, left more often than right.
We present a case of a 5-year-old female child who suddenly presented a syncope during exercise. She regained conciousness 2-3 minutes later. On admission ventricular tachycardia (125 bpm) was recorded. The ventricular tachycardia spontaneously changed in sinus rythm, with negative T waves in D1-aVL leads, QRS axis= -10°, T axis= +120°.
The echo showed a large mass in the lateral wall of the left ventricle, interfering with mitral valve function and causing mild mitral regurgitation. Tha mass did not affect neither ventricular filling or ejection. The Holter recording showed repeated runs of ventricular tachycardia (the longest of 2 minutes and the fastest of 163 bpm).
Cardiac MRI confirmed the precence of the mass (48x41 mm) in the left lateral wall.
Cardiac tumors must be considered in the evaluation of a child with cardiac syncope. The syncope can be related to obstruction of the ventricular inflow and outflow or to arrythmias. In our case syncope was caused by ventricular tachycardia induced by the tumor. Indication for surgical remove and possible risks are discussed.

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