The results confirm that the implantation of aortic prostheses improves patients' health-related quality of life, over time bringing it close to the general population's levels.

Primary sarcoma of the heart is a rare disease that has an ominous prognosis with either medical or surgical therapy. We report a case of a 25-year-old woman with sarcoma of the heart who received a transplant and is clinically well after 7 years. We believe that transplantation must be considered in this kind of pathology for selected cases.(Ann Thorac Surg 2010;90:635-6) © 2010 by The Society of Thoracic Surgeons P rimary tumors of the heart are rare clinical entities and represent 0.001% to 0.03% of all cardiac surgical cases [1-3]; of these, 25% are malignant tumors, and among them, sarcomas are the most prevalent. Sarcomas of the heart are known to be highly invasive, and when the diagnosis is made, about 80% are already disseminated. Average survival at 9 months is 10% [2].The best therapeutic options for these patients are still being discussed. Total resection is not possible for most patients, and the local recurrence rate is very high. Transplantation has certainly been an option for selected isolated cases, but long-term results and precise indications are still not clear [1].Our patient was a 25-year-old woman who was diagnosed with Hodgkin lymphoma at age 16 years. She was treated with chemotherapy and mediastinal radiotherapy and experienced total remission. As sequela, she had some degree of lung fibrosis and hypothyroidism.In August 2001, the patient was unexpectedly admitted to the hospital with complaints and signs of right-sided heart failure. An echocardiogram showed a tumor mass filling the right ventricular cavity, and a computed tomography scan and cardiac magnetic resonance imaging confirmed those findings and excluded any other locations. Without other diagnosis and given her severe New York Heart Association functional class IV condition, she underwent an open heart operation.A biopsy specimen was obtained from the tumor mass inside the right ventricle, and the pathology report identified sarcoma. Considering the ominous result, partial debulking of the tumor was done, trying to maintain the cavity-filling function of the ventricle without putting the patient at risk with a too-aggressive resection, namely at the septal area where we could create a ventricular septal defect.The patient's postoperative period was without complications. She was referred for chemotherapy and underwent a perfusion of ifosfamide (1500 mg/m 2 ) for 3 days. One month later, she was readmitted with gross rightsided heart failure, and the echocardiogram showed extensive recurrence of the tumor mass, with protrusion of the tumor through the tricuspid valve into the right atrium (Fig 1). At this point, there seemed to be no other medical or surgical options owing to the type of the recurrent tumor involving the heart. Computed tomography scans and liver and bone perfusion scans were able to exclude any metastasis or invasion at distant locations, and cardiac transplantation came as a last option.The patient underwent cardiac transplantation in December 2001 that was performed with a biatrial technique. The tumor i...

Most patients improved both physically and mentally after surgery, and most of the improvement occurred within 3 months post-surgery. These improvement patterns should be taken into account when creating rehabilitation programmes, and patients should be counselled on what improvements can be expected during the first 12 months after surgery.