Coronary-Sparing Resection of a Pediatric Left Ventricular Fibroma Involving the Left Circumflex Artery: Six-Year Follow-Up

Abstract

Left ventricular (LV) fibromas in children can pose major surgical challenges when epicardial coronary arteries are involved. We report the case of a 3-month-old female diagnosed with a large intramyocardial LV fibroma causing mitral valve compression and traversed by the left circumflex coronary artery. Multimodality imaging, including cardiac magnetic resonance imaging and coronary angiography, was essential for surgical planning. Progressive tumor growth, causing compression of the left lung and worsening mitral regurgitation, prompted partial tumor resection with mitral valvuloplasty at 23 months of age at Boston Children's Hospital, preserving the intratumoral left circumflex artery. Six years later, the patient remains asymptomatic, with stable residual tumor size, preserved LV function, and no clinically significant arrhythmias. This case illustrates the durability and safety of a conservative, coronary-sparing surgical strategy in selected pediatric patients with ventricular fibromas involving major coronary arteries.