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Wang B, Liu L. Complete resection of a giant intrapericardial cardiac synovial sarcoma. J Cardiothorac Surg 2024; 19:243. [PMID: 38632629 PMCID: PMC11025272 DOI: 10.1186/s13019-024-02725-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
Synovial sarcoma of the heart is a rare tumor. Herein we would like to report a case of giant intrapericardial cardiac synovial sarcoma that originated from the right ventricle and grew outward near the diaphragm. After making adequate preoperative preparation, we performed the surgery as quickly as possible and resected the tumor completely. Based on the identification of the translocation on chromosome 18 rearrangement, the tumor can be diagnosed as a primary cardiac synovial sarcoma. Through this study, we aim to afford more information about cardiac synovial sarcomas as well as a reference for similar cases.
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Affiliation(s)
- Binyue Wang
- Department of Cardiovascular Surgery, Tongji Hospital affiliated to Tongji Medical College, Huazhong University of Science & Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei Province, 430030, China
| | - Ligang Liu
- Department of Cardiovascular Surgery, Tongji Hospital affiliated to Tongji Medical College, Huazhong University of Science & Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei Province, 430030, China.
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2
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Luo Y, Gong K, Xie T, Liu R, Guo H, Wang L, Tan Z, Hu SJ, Yang Y, Xie L. Case Report: A Young Man With Giant Pericardial Synovial Sarcoma. Front Cardiovasc Med 2022; 9:829328. [PMID: 35155638 PMCID: PMC8829043 DOI: 10.3389/fcvm.2022.829328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/03/2022] [Indexed: 11/20/2022] Open
Abstract
Pericardial synovial sarcomas are sporadic tumors. Herein, we report a case of primary pericardial synovial sarcoma originating from the right pericardium. Missed diagnosis delayed surgical treatment. Eventually, the tumor occupied the almost entire pericardial cavity. The pericardial tumor was surgically removed as soon as possible after admission. In this paper, we aim to provide details that can help further understand the differing symptoms and presentations of pericardial synovial sarcoma and highlight the importance of consideration of this disease in similar cases where the etiology of pericardial effusion is unknown.
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Affiliation(s)
- Yong Luo
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Ke Gong
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Ting Xie
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Ruilin Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Hui Guo
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Lei Wang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Zhiping Tan
- The State Key Laboratory of Medical Genetics, The Clinical Center for Gene Diagnosis and Therapy, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Shi jun Hu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Yifeng Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Li Xie
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
- *Correspondence: Li Xie
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3
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Luo L, Zhao W, Wang Y, Liu K. Cardiac angiosarcoma: A case report and review of the literature. Echocardiography 2021; 38:2083-2090. [PMID: 34806222 DOI: 10.1111/echo.15221] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/18/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022] Open
Abstract
Primary cardiac tumors are extremely rare, among which malignancies comprise about 15-25%. As the most common type of primary cardiac malignancies, angiosarcomas tend to arise in the right heart, especially right atrium. In this case report, we presented a 32-year-old female with primary cardiac angiosarcoma in the right atrial appendage detected by transesophageal echocardiography, as it is difficult to display on conventional transthoracic echocardiography.
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Affiliation(s)
- Limin Luo
- Department of Echocardiography, Zhongshan Hospital Fudan University Xiamen Branch, Xiamen City, Fujian Province, China
| | - Weipeng Zhao
- Department of Echocardiography, Zhongshan Hospital Fudan University Xiamen Branch, Xiamen City, Fujian Province, China.,Department of Echocardiography, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yongshi Wang
- Department of Echocardiography, Zhongshan Hospital Fudan University Xiamen Branch, Xiamen City, Fujian Province, China.,Department of Echocardiography, Zhongshan Hospital Fudan University, Shanghai, China
| | - Kun Liu
- Department of Pathology, Zhongshan Hospital Fudan University Xiamen Branch, Xiamen City, Fujian Province, China
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4
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Monteagudo-Vela M, Riesgo-Gil F, Smail H, García-Saez D, Hassan B, Simon A. Cardiac tumors invading the right ventricle; Aggressive Surgical Management with backup mechanical circulatory support if necessary. Surg Oncol 2020; 34:190-194. [PMID: 32891328 DOI: 10.1016/j.suronc.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 03/09/2020] [Accepted: 04/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Primary cardiac tumors are exceedingly rare. Amongst the malignant types, sarcomas are the most frequently encountered. Treatment includes attempted aggressive surgical resection as the only curative option. We report our experience. METHODS During the last five years, six patients presented at our institution with complex cardiac tumors with different underlying diagnoses and were at different stages of their disease. RESULTS 6 patients with median age of 30-years-old underwent surgery in our centre. 3 patients had undergone debulking prior to surgery at our institution. In all patients, the tumor involved the right ventricle. One patient had biventricular involvement, the septum was involved in 4 patients, 2 patients had extracardiac growth, one invading both great vessels, one involving the pericardium and the hilar structures on the right side. Complete resection was achieved in 4 cases, 3 with successful resection-reconstruction, one with cardiectomy and implantation of a total artificial heart. 5 patients are currently alive, 4 free of recurrence. CONCLUSIONS Complete radical surgery is the only curative treatment for patients suffering from cardiac tumors. The availability of mechanical circulatory support allows for a more radical surgical approach even including total cardiectomy, possibly resulting in a significant increase in R0 resections.
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Affiliation(s)
- María Monteagudo-Vela
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - Fernando Riesgo-Gil
- Department of Heart Failure, Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Hassiba Smail
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Diana García-Saez
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Bass Hassan
- Department of Medical Oncology, Oxford University Hospital NHS Foundation Trust, UK
| | - André Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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5
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Xiao J, Brozzi N, Cifuentes R, Ghodsizad A, Loebe M. Application of total artificial heart in patients with primary malignant cardiac tumors-current treatment strategies. Ann Cardiothorac Surg 2020; 9:113-115. [PMID: 32309160 DOI: 10.21037/acs.2020.02.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jiewen Xiao
- Division of Thoracic Transplantation & Mechanical Circulatory Support, Department of Surgery, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Nicolas Brozzi
- Division of Thoracic Transplantation & Mechanical Circulatory Support, Department of Surgery, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Renzo Cifuentes
- Division of Thoracic Transplantation & Mechanical Circulatory Support, Department of Surgery, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Ali Ghodsizad
- Division of Thoracic Transplantation & Mechanical Circulatory Support, Department of Surgery, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Matthias Loebe
- Division of Thoracic Transplantation & Mechanical Circulatory Support, Department of Surgery, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
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Noly PE, Ben Ali W, Lamarche Y, Carrier M. Status, Indications, and Use of Cardiac Replacement Therapy in the Era of Multimodal Mechanical Approaches to Circulatory Support: A Scoping Review. Can J Cardiol 2020; 36:261-269. [DOI: 10.1016/j.cjca.2019.11.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 12/19/2022] Open
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Yanagawa B, Chan EY, Cusimano RJ, Reardon MJ. Approach to Surgery for Cardiac Tumors: Primary Simple, Primary Complex, and Secondary. Cardiol Clin 2019; 37:525-531. [PMID: 31587792 DOI: 10.1016/j.ccl.2019.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Cardiac tumors are rare. Most surgeons will encounter few primary cardiac tumors outside of myxomas. This article offers the authors' approach to simple and complex primary and secondary cardiac tumors. Symptoms of primary cardiac tumors are primarily determined by tumor size and anatomic location. Most simple primary tumors and some complex primary tumors are best managed by surgical resection. Secondary tumors are 30 times more frequent than primary cardiac tumors. Surgical resection of secondary tumors is rational in a few highly selected patients. For complex primary and secondary tumors, the authors recommend referral to an experienced multidisciplinary cardiac tumor team.
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Affiliation(s)
- Bobby Yanagawa
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON M5B 1W8, Canada
| | - Edward Y Chan
- Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, Suite 1401, Houston, TX 77030, USA
| | - Robert J Cusimano
- Division of Cardiac Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, 6550 Fannin Street, Suite 1401, Houston, TX 77030, USA.
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8
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Saadat S, Chen FY. Making the Rare Diagnosis: Trust Yourself, Your Colleagues, or Both? J Cardiothorac Vasc Anesth 2019; 33:2091-2092. [PMID: 30795970 DOI: 10.1053/j.jvca.2018.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Siavash Saadat
- Division of Cardiothoracic Surgery, Tufts Medical Center, Boston, MA
| | - Frederick Y Chen
- Division of Cardiothoracic Surgery, Tufts Medical Center, Boston, MA
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9
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Deceiving spindle cell sarcoma of the heart. Indian J Thorac Cardiovasc Surg 2018; 35:218-221. [PMID: 33061010 DOI: 10.1007/s12055-018-0754-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 10/28/2022] Open
Abstract
Primary cardiac tumors are rare and when they occur, 75% are benign. Atrial myxomas having a good prognosis compromise 50% of all primary cardiac tumors. Only 25% of the primary cardiac tumors are malignant and 75% of these malignant tumors are sarcomas. Sarcomas often occur in young patients without any predisposing factors and tend to have very poor prognosis. We present an unfortunate case of a young female with high-grade spindle cell sarcoma. She was initially diagnosed to have mitral valve pathology and hypertrophic cardiomyopathy but confirmation of diagnosis was made only after a second operation and patient's demise.
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10
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Yanagawa B, Mazine A, Chan EY, Barker CM, Gritti M, Reul RM, Ravi V, Ibarra S, Shapira OM, Cusimano RJ, Reardon MJ. Surgery for Tumors of the Heart. Semin Thorac Cardiovasc Surg 2018; 30:385-397. [PMID: 30205144 DOI: 10.1053/j.semtcvs.2018.09.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/04/2018] [Indexed: 11/11/2022]
Abstract
Most surgeons will encounter only a handful of primary cardiac tumors outside of myxomas. Approximately 3 quarters of primary cardiac tumors are benign and 1 quarter is malignant. In most cases, cardiac tumors are silent but when symptoms do occur, they are primarily determined by tumor size and anatomical location, not by histopathology. The diagnosis and preoperative imaging relies heavily on multimodal imaging including echocardiography, computed tomography, magnetic resonance imaging, and coronary angiography. Surgical resection is the most common treatment for most simple primary cardiac tumors and for some complex benign tumors. Surgical resection of primary cardiac tumors frequently involves the need for complex cardiac reconstruction, particularly when malignant. Secondary tumors to the heart are 30 times more frequent than primary cardiac tumors, and their incidence is increasing, largely as a result of advances in cancer diagnosis and therapy. Surgical resection is feasible in only a small fraction of highly-selected patients with secondary tumors to the heart. For complex benign tumors-such as paraganglioma or large fibromas-and all primary and secondary malignant tumors, a multidisciplinary cardiac tumor team review in experienced centers of excellence is recommended.
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Affiliation(s)
- Bobby Yanagawa
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Amine Mazine
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Edward Y Chan
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Colin M Barker
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Michael Gritti
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ross M Reul
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Vinod Ravi
- Department of Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Sergio Ibarra
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Oz M Shapira
- Department of Cardiothoracic Surgery, Hebrew University, Hadassah Medical Center, Jerusalem, Israel
| | - Robert J Cusimano
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
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11
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Coli A, Chiariello GA, Novello M, Colizzi C, Massetti M. Treatment of cardiac synovial sarcoma: experience of two cases. J Cardiothorac Surg 2018; 13:84. [PMID: 29970129 PMCID: PMC6029359 DOI: 10.1186/s13019-018-0771-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 06/22/2018] [Indexed: 12/15/2022] Open
Abstract
Background Primary heart sarcomas are exceedingly rare tumors. Among primary cardiac sarcomas, synovial sarcoma is one of the rarest, involving cardiac cavities or pericardium. Case presentation Two cases of synovial sarcoma are presented with the clinical course and therapy. Both cases were treated with surgery and chemo/radiotherapy. Interestingly, one of the patient, a 52-year-old male with an intracardiac synovial sarcoma, undergone a SynCardia total artificial heart implantation, but died for multiple pulmonary metastases waiting for transplantation. Conclusion Complete surgical resection of cardiac synovial sarcoma is the gold standard of therapy, though rarely possible. Although guidelines for the treatment are not well established, due to limited number of cases reported, chemotherapy and radiotherapy are frequently administered and seem to prolong mean patient’s survival. Cardiac transplantation could be considered in selected cases.
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Affiliation(s)
- Antonella Coli
- Institute of Anatomic Pathology, Catholic University of Sacred Heart, Largo F. Vito 1, 00168, Rome, Italy.
| | | | - Mariangela Novello
- Institute of Anatomic Pathology, Catholic University of Sacred Heart, Largo F. Vito 1, 00168, Rome, Italy
| | - Christian Colizzi
- Department of Cardiovascular Sciences, Catholic University of Sacred Heart, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Catholic University of Sacred Heart, Rome, Italy
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12
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Mkalaluh S, Szczechowicz M, Torabi S, Schmack B, Sabashnikov A, Dib B, Karck M, Weymann A. Surgical Treatment of Cardiac Tumors: Insights from an 18-Year Single-Center Analysis. Med Sci Monit 2017; 23:6201-6209. [PMID: 29289957 PMCID: PMC5757895 DOI: 10.12659/msm.905451] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background The aim of this study was to investigate the clinical presentation, operative data, and early and late outcomes of a large patient cohort undergoing surgical treatment for cardiac tumors in our institution. Material/Methods A total of 181 patients underwent surgery because of suspected cardiac tumor in our institution between 1998 and 2016. In 162 cases, the diagnosis was confirmed postoperatively and these patients were included in this study. Preoperative baseline characteristics, operative data, and postoperative early and long-term outcomes were analyzed. Results Mean age at presentation was 56.6±17.6 years, and 95 (58.6%) patients were female. There were 126 (77.8%) patients with benign cardiac tumors, while the remaining patients had malignant tumors (primary and metastasized). The mean follow-up time was 5.2±4.7 years. The most frequent histologically verified tumor type was myxoma (63%, n=102). In terms of malignant tumors, various types of sarcomas presented most primary malignant cardiac tumors (7.4%, n=12). The mean ICU length of stay was 1.7±2.2 days and overall in-hospital mortality was 3.1% (n=5). Frequent postoperative complications included mediastinal bleeding (5.8%, n=9), wound infection (1.3%, n=2), acute renal failure (5.6%, n=9), and major cerebrovascular events (n=7, 4.6%). The overall cumulative survival after cardiac tumor resection was 94% at 30 days, 85% at 1 year, 72% at 5 years, and 59% at 15 years. Conclusions Surgical treatment of cardiac tumors is a safe and highly effective strategy associated with good early and long-term outcomes.
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Affiliation(s)
- Sabreen Mkalaluh
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Marcin Szczechowicz
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Saeed Torabi
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Bastian Schmack
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Bashar Dib
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany
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13
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Kremer J, Farag M, Arif R, Brcic A, Sabashnikov A, Schmack B, Popov AF, Karck M, Dohmen PM, Ruhparwar A, Weymann A. Total Artificial Heart Implantation After Undifferentiated High-Grade Sarcoma Excision. Med Sci Monit Basic Res 2016; 22:128-131. [PMID: 27803495 PMCID: PMC5103823 DOI: 10.12659/msmbr.901526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Total artificial heart (TAH) implantation in patients with aggressive tumor infiltration of the heart can be challenging. Case Report We report on a patient with a rare primary undifferentiated high-grade spindle cell sarcoma of the mitral valve and in the left atrium, first diagnosed in 2014. The referring center did a first resection in 2014. In the course of 17 months, computer tomography (CT) scan again showed massive invasion of the mitral valve and left atrium. Partial resection and mitral valve replacement was not an option. We did a subtotal heart excision with total artificial heart implantation. In this report we discuss complications, risk factors, and perioperative management of this patient. Conclusions Patients with aggressive tumors of the heart can be considered for TAH implantation.
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Affiliation(s)
- Jamila Kremer
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Mina Farag
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Rawa Arif
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Andreas Brcic
- Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, London, United Kingdom
| | - Bastian Schmack
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, London, United Kingdom
| | - Aron-Frederik Popov
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, London, United Kingdom
| | - Matthias Karck
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Pascal M Dohmen
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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