Cardiac ventricular fibroma with surgical excision, late recurrence and refractory heart failure: Case report and a brief review of the literature

Primary cardiac tumors are exceedingly rare in the pediatric population, with cardiac fibromas (CFs) representing the second most common benign neoplasm. Although histologically benign, these intramural tumors frequently precipitate life-threatening, intracavitary obstruction, and sudden cardiac death. We present the case of a 9-year-old male who presented with exercise-induced syncope and was found to have a large, arrhythmogenic interventricular septal fibroma. The patient underwent successful complete surgical excision with patch reconstruction, resulting in immediate resolution of his arrhythmia burden. However, 5 years postoperatively, he developed a late, infiltrative recurrence at the patch margin, precluding complete re-resection. Despite partial debulking and implantable cardioverter-defibrillator placement, the patient experienced progressive left ventricular dysfunction and refractory heart failure, ultimately succumbing to the disease at age 19 while awaiting heart transplantation. This case underscores the unpredictable long-term biological behavior of cardiac fibroma. It highlights the critical diagnostic role of multimodal imaging, the surgical challenges of septal reconstruction, and the rare but devastating potential for late recurrence. Furthermore, it emphasizes the necessity of lifelong surveillance and the complex interplay between repeated surgical interventions, chronic arrhythmia, and progressive myocardial failure in pediatric patients with recurrent cardiac fibromas.