Liposarcoma causing left ventricular outflow tract obstruction and syncope: a case report and review of the literature

Anesthetic management of the removal of a giant metastatic cardiac liposarcoma occupying right ventricle and pulmonary artery

A 60 years old chinese male scheduled for a removal of an intracardiac mass occupying majority of right ventricular space, right ventricular outflow tract and pulmonary artery. The giant cardiac mass was later diagnosed pathologically as metastatic liposarcoma. The patient had a history of surgical removal of myxoid liposarcoma from his left thigh many years ago. It is extremely rare for liposarcoma to metastatize to right ventricle and pulmonary artery. The anesthetic management of the surgical procedure to remove this kind of intracardiac mass poses significant challenges to anesthesia providers. Our patient developed refractory hypotension after induction of general anesthesia which necessitated urgent cardiopulmonary bypass. The surgical procedure was successful and the patient recovered from the surgery and was discharged home without significant complication. Accurate preoperative diagnosis and assessment of patient's functional status, appropriate preoperative volume status, emergency cardiopulmonary bypass readiness, smooth and gentle induction of general anesthesia with less myocardial depressing agent, and closely monitoring patient's vitals and hemodynamic parameters are imperative in managing this kind of patients.

Robotic-assisted excision of a left ventricular thrombus

OBJECTIVE

: Left ventricular thrombus is a rare entity usually associated with myocardial infarction. The daVinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, Calif) offers excellent visualization of the mitral subvalvular apparatus and should provide an effective means to excise a left ventricular mass.

METHODS

: A 34-year-old man presented to an outside institution with fever of unknown origin and ulcerative colitis. As part of this workup, he underwent a transthoracic echocardiogram and subsequently a transesophageal echocardiogram that showed a 2-cm left ventricular apical pedunculated mass. He was referred to our institution for excision of this ventricular mass. Because of the pedunculated nature of the mass, he was deemed a candidate for a robotic-assisted minimally invasive approach.

RESULTS

: The patient underwent successful robotic-assisted excision of a left ventricular mass. Total robotic time was 15 minutes. Pathology revealed that the mass was a left ventricular thrombus. The patient experienced an uneventful recovery and was discharged home in 4 days.

CONCLUSIONS

: Left ventricular mass excision can be safely performed with the daVinci Surgical System. The daVinci Surgical System offers excellent visualization of the entire left ventricular cavity.

Metastatic liposarcoma of the heart. Case series and brief literature review

Secondary cardiac tumors are 20-40 times more frequent than primary lesions. Primary cardiac lesions are represented by myxomas when related to benign tumors, and by sarcomas in terms of malignant disease. Metastases to the heart from liposarcomas are very rare. We present three cases of secondary liposarcomas involving the left atrium, the right atrium, and the pericardium.

The first case report of a metastatic myxoid liposarcoma invading the left atrial cavity and pulmonary vein

Myxoid liposarcoma (MLS) is the most commonly encountered liposarcoma subgroup, accounting for about 50% of all cases. Metastatic MLS of the heart is extremely rare. Herein we describe for the first time metastasis of MLS to the left atrium and left upper pulmonary vein in a 54-year-old woman who was admitted with shortness of breath and cough persisting for 2 weeks. The patient reported that a total surgical excision of MLS of the left thigh followed by radiotherapy was performed 4 years ago. An emergency operation was performed due to rapidly progressive worsening of clinical condition and echocardiographic determination of left atrial mass protruding into the left ventricle and obstructing the mitral inflow throughout the diastole. The mass could not be totally excised because it was tightly adhered to the surrounding tissue. Postoperative magnetic resonance imaging (MRI) showed a 5 × 3 cm residual tumor deforming the posterior wall of the left atrium entirely and extending into the left upper pulmonary vein. Histopathological examination was consistent with MLS. In conclusion, considering probable cardiac metastasis in patients presenting with respiratory symptoms with medical history of soft tissue sarcomas would be life saving. The case is discussed, and a review of the literature in relation to the metastatic involvement of the heart by MLS is presented.

A case of stroke due to tumor emboli associated with metastatic cardiac liposarcoma

Cardioembolic stroke due to tumor emboli is a rare complication of neoplasm. A patient with metastatic cardiac liposarcoma who suffered from embolic stroke is reported. Autopsy confirmed that the cardiac tumor was a metastatic liposarcoma from the retroperitoneum, and the cerebral vessel was occluded by tumor cells and fibrin clot.

Metastatic shoulder liposarcoma to the right ventricle: CT findings

Metastatic cardiac liposarcoma is rare. A right ventricular liposarcoma metastasis is described in a 46-year-old man, who was admitted with significant shortness of breath and fatigue, and in whom a large lobulated low attenuation mass occupying most of the right ventricular cavity, with extension through the right ventricular apex and a small-to-moderate pericardial effusion was detected by electrocardiogram-gated cardiac computed tomography. The patient had an antecedent history of a left upper arm liposarcoma treated with surgical resection, chemotherapy, and postoperative radiotherapy 3 years earlier. Surgical resection was performed with the majority of the neoplasm removed though; the right ventricular apex and epicardial extension of tumor could not be fully resected. The histopathologic analysis revealed a liposarcoma, similar to the one resected in the left arm 3 years earlier. Electrocardiogram-gated cardiac computed tomography was able to visualize the metastatic tumor within the heart, accurately evaluate cardiac function and allow for prompt surgical treatment that produced relief of symptoms, and assess for further metastatic disease within the thorax.