Conservative management of left ventricle cardiac fibroma in an adult asymptomatic patient

Primary cardiac tumours are rare with an autopsy frequency of 0.001–0.03% and approximately 90% of them are benign. Among these, cardiac fibromas represent a minority and, together with rhabdomyomas, are the most common benign cardiac tumours in paediatric patients. However, their occurrence in the adult patient is uncommon. Most originate from the left ventricle (LV) or interventricular septum. Patients with cardiac fibroma usually present with chest discomfort or pain, syncope, heart failure, cyanosis, arrhythmias or even sudden death but approximately one third of patients diagnosed with cardiac fibroma are asymptomatic and the tumour is discovered incidentally. There is a general agreement that surgical treatment should be performed whenever the cardiac fibroma is causing symptoms. In these patients, surgical options include complete surgical excision, partial resection or orthotopic heart transplantation. Indication for surgical treatment remains controversial in patients who are strictly asymptomatic. We report the case of an asymptomatic adult patient presenting with a giant LV cardiac fibroma and for whom we have opted for a conservative management. Conservative management of LV cardiac fibroma in an adult patient who is strictly asymptomatic seems to be an acceptable strategy when the risks of complete surgical resection outweigh the benefits. Close clinical and instrumental follow-up is mandatory and the implantation of an ICD might be a reasonable precaution.