CLINICAL SPOTLIGHT Clinical Spotlight Hamartoma of Mature Cardiac Myocytes: Case Report and Review of the Literature Andrea Dell’Amore, MD a,∗ , Giuseppe Lanzanova, MD b , Andrea Silenzi, MD a and Mauro Lamarra, MD a a Department of Cardiovascular and Thoracic Surgery, GVM Hospital for Care and Research, Cotignola, Lugo, RA, Italy b Department of Surgical Pathology, Civil Hospital, Lugo, RA, Italy Cardiac hamartoma is an extremely rare type of benign cardiac tumour. A 35 year-old female presented with exertional dyspnea, palpitation, dry-cough and chest-tightness. A mass was discovered in the posterior–inferior wall of the left ventricle. A partial resection of the tumour was performed because of partial obstruction of the left ventricular inflow tract. Histological examination was indicative of a rare benign tumour of the heart: hamartoma of mature myocytes. A literature review completes the description. (Heart, Lung and Circulation 2011;20:336–340) © 2011 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved. Keywords. Cardiac tumour; Benign tumour; Heart; Cardiac hamatoma Introduction C ardiac hamartoma is an extremely rare type of benign cardiac tumour and, to our knowledge, has been reported in only 21 patients worldwide [1–5]. This benign tumour is characterised by disorganised and hypertro- phied myocytes with a variable collagen expression [2]. We report a further case of cardiac hamartoma in a young female who had symptoms related to left ventricular inflow obstruction mimicking mitral valve stenosis. Case Report A 35 year-old Balkan female was admitted because of exertional dyspnea, palpitation, dry-cough and chest- tightness for three months. She had history of smoking, anxious depressive syndrome and pigmentary synovi- tis of the right knee. The family history was negative for genetic or cardiovascular disease and she had seven healthy children. The physical examination was unre- markable apart from a soft diastolic murmur in the mitral position. Electrocardiography showed non-specific alterations, inverted T-waves in the inferior leads and a P-mitrale. Echocardiography showed a hyperintense oval mass of 4.2 cm × 3.3 cm × 2.7 cm along the posterior–inferior Received 26 July 2010; received in revised form 11 January 2011; accepted 17 January 2011; available online 25 February 2011 ∗ Corresponding author at: GVM Hospital for Care and Research, V. Corriera n.1, Cotignola, Lugo, RA, Italy. Tel.: +39 3356223366. E-mail address: dellamore76@libero.it (A. Dell’Amore). and mid-basal segments of the left ventricle (Fig. 1A). Overall systolic function of the ventricle was normal without any notable valvular pathology. The mass was protruding into the left ventricular cavity creating an obstruction to the diastolic filling of the left ventricle by two mechanisms: a partial mechanical obstruction of left ventricular inflow (9 mmHg mean flow gradient), and loss of contractility of the involved wall segments creat- ing a diastolic dysfunction and reduced tissue-doppler velocities. Coronary-computed-tomography excluded coronary compression and found the mass to be vascularised by the right and circumflex coronary arteries. Cardiac mag- netic resonance (CMR) T2-weighted imaging showed a hyperintense signal within the mass on the left inferior ventricle wall, involving the base of the postero-medial papillary muscle. A T1-weighted image showed an iso- intense signal compared with surrounding myocardium (Fig. 1B and C). The perfusion study showed an early gadolinium uptake with an abnormal late enhancement. These findings were suggestive of a rhabdomyoma of the left ventricle. Multiple cysts of splanchnic organs were also found on CMR (Fig. 1D). Some of these cysts appeared haemorrhagic. The radiological picture suggested the diagnosis of multiple angio-myolipomas. Brain magnetic resonance and genetic screening excluded tuberous- sclerosis, which is frequently associated with cardiac rhabdomyomas [3]. The surgical decision was made to reduce the ventricular inflow obstruction by complete or partial resection of the mass and to obtain a definitive diagnosis. © 2011 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved. 1443-9506/04/$36.00 doi:10.1016/j.hlc.2011.01.015