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Richardson AC, Omar M, Velarde G, Missov E, Percy R, Sattiraju S. Right Atrial Appendage Thrombus in Atrial Fibrillation: A Case Report and Review of the Literature. J Investig Med High Impact Case Rep 2021; 9:23247096211010048. [PMID: 33899523 PMCID: PMC8082980 DOI: 10.1177/23247096211010048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Atrial fibrillation (Afib) is the most common abnormal heart rhythm in adults and has become a significant public health concern affecting 2% to 3% of the population in Europe and North America. Left atrial appendage (LAA) thrombi is the source of 90% of left-sided cardiac thrombi in patients with Afib, which can cause stroke and other systemic vascular events. Right atrial appendage (RAA) thrombi formation in Afib is much less common but complications include pulmonary embolism or paradoxical migration across patent foramen ovale with risk of systemic embolization. The prevalence and subsequent clinical complications of RAA thrombi formation in Afib patients is not well understood. Management of RAA thrombi should be similar to that of LAA thrombi which includes delaying cardioversion and anticoagulating with warfarin therapy to achieve international normalized ratio of 2 to 3.
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Affiliation(s)
| | | | | | - Emil Missov
- University of Florida, Jacksonville, FL, USA
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Richardson A, Ganji M, Omman R, Alkhasawneh A, Missov E, Sattiraju S, Percy R. Renal Cell Carcinoma with Right Ventricular Metastatic Spread: An Unusual Finding with Poor Prognosis. CASE (PHILADELPHIA, PA.) 2020; 4:374-376. [PMID: 33117932 PMCID: PMC7581567 DOI: 10.1016/j.case.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
•RCC is the most common type of renal cancer. •RCC is capable of passing through the renal vein into the IVC. •Surgical resection requiring cardiopulmonary bypass is currently the only curative treatment. •Metastatic RCC tumor spread into the heart is a poor long-term prognostic factor.
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Affiliation(s)
- Aaron Richardson
- Division of Cardiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida
| | - Maedeh Ganji
- Division of Cardiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida
| | - Reeba Omman
- Department of Pathology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida
| | - Ahmad Alkhasawneh
- Department of Pathology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida
| | - Emil Missov
- Division of Cardiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida
| | - Srinivasan Sattiraju
- Division of Cardiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida
| | - Robert Percy
- Division of Cardiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida
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Miura S, Yamada A, Iba Y, Maruyama R, Hatta E, Kurimoto Y. Surgical treatment of isolated right ventricular metastasis from renal cell carcinoma. Surg Case Rep 2019; 5:162. [PMID: 31664692 PMCID: PMC6820637 DOI: 10.1186/s40792-019-0733-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac metastasis from renal cell carcinoma is an exceptional event, particularly when there is lack of inferior vena cava involvement. Only a few cases have been reported worldwide so far. CASE PRESENTATION We presented a case of a 58-year-old man diagnosed with isolated right ventricular metastasis of renal cell carcinoma in the absence of direct inferior vena cava extension, who underwent surgical tumor resection using cardiopulmonary bypass. CONCLUSIONS Surgical resection of the cardiac mass with an understanding of the pathology is needed to prevent sudden death from acute heart failure or tumor embolism and improve the patient's quality of life.
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Affiliation(s)
- Shuhei Miura
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan.
| | - Akira Yamada
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan
| | - Yutaka Iba
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan
| | - Ryushi Maruyama
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan
| | - Eiichiro Hatta
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan
| | - Yoshihiko Kurimoto
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan
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Viteri Malone MA, Ares GR, De Velasco G, Brandão R, Lin X, Norton C, Simantov R, Moslehi J, Krajewski KM, Choueiri TK, McKay RR. The Clinical Presentation, Survival Outcomes, and Management of Patients With Renal Cell Carcinoma and Cardiac Metastasis Without Inferior Vena Cava Involvement: Results From a Pooled Clinical Trial Database and Systematic Review of Reported Cases. Clin Genitourin Cancer 2017; 16:e327-e333. [PMID: 29361425 DOI: 10.1016/j.clgc.2017.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/15/2017] [Accepted: 11/27/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cardiac metastases from renal cell carcinoma (RCC) are uncommon and there are limited data regarding the presentation and outcomes of this population. The objective of this study was to evaluate the characteristics and outcomes of patients with RCC with cardiac metastasis without inferior vena cava (IVC) involvement. MATERIALS AND METHODS We conducted a pooled retrospective analysis of metastatic RCC patients treated in 4 clinical trials. Additionally, we conducted a systematic review of cases reported in the literature from 1973 to 2015. Patients with cardiac metastases from RCC without IVC involvement were included. Patient and disease characteristics were described. Additionally, treatments, response to therapy, and survival outcomes were summarized. RESULTS Of 1765 metastatic RCC patients in the clinical trials database, 10 had cardiac metastases without IVC involvement. All patients received treatment with targeted therapy. There was 1 observed partial response (10%) and 6 patients showed stable disease (60%). The median progression-free survival was 6.9 months. The systematic review of reported clinical cases included 39 patients. In these patients, the most common cardiac site of involvement was the right ventricle (51%; n = 20). Patients were treated with medical (28%; n = 11) and/or surgical treatment (49%; n = 19) depending on whether disease was isolated (n = 13) or multifocal (n = 26). CONCLUSION To our knowledge, this is the first series to report on the presentation and outcomes of patients with cardiac metastasis without IVC involvement in RCC. We highlight that although the frequency of patients with cardiac metastases without IVC involvement is low, these patients have a unique clinical presentation and warrant special multidisciplinary management.
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Affiliation(s)
| | - Gustavo Ruiz Ares
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Raphael Brandão
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Xun Lin
- Pfizer Oncology, New York, NY
| | - Craig Norton
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Javid Moslehi
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Nashville, TN
| | | | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Rana R McKay
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, La Jolla, CA.
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Czarnecka AM, Sobczuk P, Lian F, Szczylik C. Renal cell carcinoma with intramyocardial metastases. BMC Urol 2014; 14:73. [PMID: 25193011 PMCID: PMC4158341 DOI: 10.1186/1471-2490-14-73] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 08/05/2014] [Indexed: 01/02/2023] Open
Abstract
Background Cardiac metastases from renal cell carcinoma without vena caval involvement are extremely rare with a limited number of cases reported in the worldwide literature until now. Nevertheless, this rare location of metastasis may significantly influence patient treatment and prognosis. Cooperation between oncology, cardiology, and urology teams are indispensable in cases of patients suffering from intramyocardial tumors. For these individuals, treatment guidelines based on large-scale studies are unavailable and only case/case series analysis may provide clinicians with decision assistance. Case presentation In this paper, we report a case of a 50-year-old Caucasian male diagnosed with a 10.2 × 10.3 × 10.0 cm lower pole left renal mass in January 2002. He was subsequently treated with immunochemotherapy, tyrosine kinase inhibitors (TKIs), and mTOR inhibitors (mTORIs) - that is sunitinib, everolimus, and sorafenib. In March 2012, contrast-enhancing tumors in the left myocardium (∅22 mm) and in the interventricular septum (∅26 mm) were seen on CT. Cardiology testing was conducted and the patient was treated with pazopanib with a profound response. Overall survival since the clear cell renal cell carcinoma (ccRCC) diagnosis was 11 years 2 months and since diagnosis of multiple heart metastases was 1 year. Conclusions Cardiac metastases present a unique disease course in renal cell carcinoma. Cardiac metastases may remain asymptomatic, as in the case of this patient at the time of diagnosis. The most common cardiac presentation of renal cell carcinoma is hypertension, but other cardiac presentations include shortness of breath, cough, and arrhythmias. Targeted systemic therapy with tyrosine kinase inhibitors may be useful for this group of patients, but necrosis in the myocardium can result in tamponade and death. Regular cardiac magnetic resonance imaging scans are required for treatment monitoring.
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Affiliation(s)
- Anna M Czarnecka
- Department of Oncology, Military Institute of Medicine, Warsaw, Poland.
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Ohba K, Miyata Y, Mitsunari K, Matsuo T, Mochizuki Y, Sakai H. Left atrial metastasis of renal cell carcinoma: a case report and review of the literature. BMC Res Notes 2014; 7:520. [PMID: 25115225 PMCID: PMC4267133 DOI: 10.1186/1756-0500-7-520] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 08/06/2014] [Indexed: 11/23/2022] Open
Abstract
Background Cardiac metastasis of renal cell carcinoma is an exceptional event, particularly when there is lack of inferior vena cava involvement. Indeed, only a few cases have been reported worldwide thus far. Moreover, discussion of treatment and follow-up strategies for cardiac metastasis of renal cell carcinoma is important because of the high risk of sudden death. Case presentation We report the case of a 75-year-old Japanese man with metastatic tumor in the left atrium from renal cell carcinoma. He had a history of right renal cell carcinoma, for which he had undergone hand-assisted laparoscopic nephrectomy. Lung and bone metastases were detected after nephrectomy, and treatment with interferon-alpha was initiated. After disease progression, he was treated concurrently with targeted molecular therapy and radiotherapy for bone metastasis. After these therapies, a 42 × 24 mm mass was found on transthoracic echocardiography in left atrium without involvement of the right atrium or inferior vena cava. The provisional diagnosis was metastatic mass or myxoma, and surgical resection was performed. Histopathological examination led to a final diagnosis of metastatic tumor from clear cell renal cell carcinoma. Conclusion Cardiac metastasis, metastasis to the left atrium in particular, is rare in patients with renal cell carcinoma. In our study, surgery of the cardiac mass was effective to avoid sudden death and quality of life decline resulting from heart failure. We describe this case and review cardiac metastasis of renal cell carcinoma.
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Affiliation(s)
- Kojiro Ohba
- Department of Nephro-Urology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
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