Biventricular pacing as alternative therapy for dilated cardiomyopathy associated with congenital heart disease

Biventricular, alternative, and multisite pacing are currently being explored to improve cardiac function among patients with medically refractory, end-stage dilated cardiomyopathies. Although, due to inherent myocardial abnormalities, patients with repaired congenital heart defects may be at a greater risk than others to develop heart failure, often requiring cardiac transplantation. The efficacy of biventricular pacing among these patients is unknown. This report presents a patient with successfully repaired congenital heart disease in infancy who developed a symptomatic dilated cardiomyopathy at 22 years of age. Following biventricular pacing, systemic ventricular function showed a 14% improvement in ventricular dP/dt. One month later, subjective symptoms improved and cardiac ultrasound illustrated a 125% increase in fractional area of change. Exercise stress testing showed a 17% improvement in aerobic work capacity.

Treatment of primary cardiac malignancies with orthotopic heart transplantation

OBJECTIVE

Heart transplantation has become available as a possible treatment for patients with malignancies. Primary cardiac malignant tumors are extremely rare but several patients have been treated with this modality. Whether survival is improved over the direct removal of tumor or heart transplantation is not known. We compiled data regarding malignant primary heart tumors that have been treated at various transplant centers in order to determine if early diagnosis and treatment with cardiac transplantation has resulted in an improved mortality.

METHODS

A total of 173 questionnaires were sent to the heart transplant centers across the United States and Canada inquiring about those patients who were found to have a primary cardiac malignant tumor and who underwent heart transplantation. Cases reported in the literature, which had undergone transplantation, were also reviewed by a search in MEDLINE.

RESULTS

Twenty-four cases were collected. The overall survival time was from 1 month to 66 months. The actuarial survival was 54% at 12 months, 45% at 24 months and 35% at 36, 48 and 60 months respectively. Metastases were present in 10 out of the 14 deceased patients, possibly being one of the major factors affecting survival. Only 1 living patient developed metastases.

CONCLUSION

Survival rates of patients with primary cardiac malignancies treated with resection, radiation, chemotherapy, or a combination of them (conventional therapy) versus heart transplantation are similar. Early diagnosis and resection are the most important factors for a better outcome, however these factors will not guarantee success since the presence or development of metastasis is a major contributor to death in both groups of patients.

Primary cardiac osteogenic sarcoma treated with heart transplantation

Primary cardiac osteogenic sarcomas are rare malignancies. Less than 30 cases have been reported in the literature. Most of them have been found in the left side of the heart. We report a case of a primary osteogenic sarcoma of the left atrium in a 28 year old female. She underwent resection of the tumor and subsequently heart transplantation. To our knowledge this is the second patient with a primary cardiac osteosarcoma who underwent heart transplantation.

Primary cardiac myofibroblastic sarcoma, case report and review of diagnosis and treatment of cardiac tumors

Primary cardiac tumors are rare entities with a frequency between 0.0017% to 0.28%. We report a 53 year old male with a primary cardiac myofibroblastic sarcoma that presented with a hemorrhagic pericardial effusion. A review of the literature is presented with a brief discussion of the clinical presentation diagnosis and treatment of benign and malignant primary cardiac tumors.