1, heart ventricular wall tumor is not a tumor When it comes to “tumor”, people always think of “tumor”, which is not surprising. The most important thing is that it is not a tumor. Therefore, people’s habitual thinking is that when they see the word “tumor”, they think of “tumor” and “malignant tumor”. However, it is true that although tumors can grow in the heart (such as mucinous tumors or sarcomas), cardiac ventricular tumors are a completely different concept, and they are not really tumors that occur as a result of cellular mutations or changes in the heart tissue. 2.What exactly is a ventricular tumor? When myocardial infarction occurs in severe cases of coronary artery disease, the infarcted myocardial tissue is gradually replaced by fibrous scar tissue, thus losing its normal contraction capacity, and the tissue at the fibrotic site becomes thinner and expands outward (paradoxical movement) under the action of cardiac contraction and pressure in the heart chambers. This part of the loss of function is so prominent in appearance that it resembles an expanding growth of a tumor, both in terms of imaging and anatomy, and is therefore called a ventricular wall tumor of the heart. Therefore, it can be said that ventricular wall tumors are an extremely serious comorbidity of coronary artery disease. The majority of ventricular wall tumors occur in the left ventricle, and there is a clinical distinction between true and false ventricular wall tumors. True ventricular wall tumors: thin walls, myocardial tissue in the ventricular wall replaced by scar tissue, reduced or absent motion in the area, loss of endocardial trabecular structures or possible wall thrombus formation. Pseudoventricular wall tumors: are usually the result of rupture of the free wall of the ventricle and are a pathological process of chronic or subacute ventricular rupture. The rupture is due to a rupture of a certain area of the myocardial infarction zone, and the rupture is wrapped or blocked by the outer epicardium (the dirty pericardial layer) and the mechanized blood clot of the pericardial adhesions, forming a diverticulum, or pseudoventricular wall tumor, in the left ventricle, with the tumor cavity directly communicating with the left ventricle. Therefore, pseudoventricular wall tumors do not contain cardiomyocytes, but only epicardial or pericardial tissue or mechanized blood clots. Unlike true ventricular wall tumors, pseudoventricular wall tumors often have a smaller neck and a greater propensity to rupture. Acute ventricular rupture does not form a pseudoventricular tumor because of acute cardiac tamponade death within minutes due to a large influx of blood into the pericardial cavity. 3. How to diagnose and treat ventricular wall tumors The diagnosis of ventricular wall tumors is generally not difficult to make. The diagnosis is based on patient history and symptoms, cardiac ultrasound, and coronary artery and ventriculography. Whether a ventricular wall tumor is true or pseudoventricular, it is an indication for aggressive surgical procedures if symptoms are present. Ventricular wall tumors inevitably affect ventricular systolic function and are associated with complications such as appendage thrombosis and rupture; moreover, the prognosis for medical treatment alone is poor. Surgical removal of the ventricular wall tumor, repair of the rupture, and left ventricular reconstruction with simultaneous coronary artery bypass grafting are the most effective means of saving the patient’s life and altering his or her prognosis. Patients who undergo surgery and survive the perioperative period will not only experience symptom relief and improved quality of life, but also have a much better chance of survival. In recent years, our hospital has always encountered many such patients every year, and the treatment and salvage results are very satisfactory. Even in the case of huge ventricular wall tumors, as long as surgery is taken in time, good results can be achieved. 4, timing of surgery Patients with suspected or occurring left ventricular wall tumors after myocardial infarction should be closely hospitalized for observation and follow-up. Once symptoms such as angina pectoris, congestive heart failure, recurrent ventricular arrhythmias, and embolism of the body circulation appear, surgery should be considered as soon as possible; the indications for surgery are even clearer when signs of ventricular rupture or pseudoventricular wall tumors appear. In addition, surgery is now advocated in asymptomatic patients with severe coronary artery disease and signs of progressive deterioration of left ventricular function (decreased left ventricular ejection fraction and increased mitral regurgitation).