A case of primary cardiac angiosarcoma with surgical resection and reconstruction

Yada, Masashi; Tara, Yuichi; Sato, Shun; Sekine, Yuji; Nishina, Tomohiro; Yamanaka, Kazuhiro; Ueda, Yuichi

doi:10.1016/j.jccase.2021.07.012

Cited by 6 publications

(7 citation statements)

References 6 publications

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“…As recommended by other authors, adjuvant chemotherapy should be considered in all patients (10). Even if there are no clear recommendations or clearly designed protocols for radiotherapy or targeted therapy as adjuvants to surgery, it has been reported that they may improve survival, especially in patients with R1 resection (10,13).…”

Section: Discussionmentioning

confidence: 98%

Surgical resection of a giant cardiac angiosarcoma and reconstruction of involved right heart structures: A case report

Blindaru

Vasilescu²,

Danet³

et al. 2023

Front. Cardiovasc. Med.

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We present the case of a young woman without a medical history who presented with a giant right atrial, transtricuspid, and right ventricular mass and in a severe clinical state. Multimodal imaging raised the suspicion of primary cardiac angiosarcoma. Due to rapid hemodynamic and respiratory deterioration, we were forced to perform surgical removal of the mass with a concomitant reconstruction of the involved right heart structures, only 48 h after presentation. The postoperative course was uneventful, and the patient was discharged from the intensive care unit 2 days later. Radical surgical resection with reconstruction of the resected heart structures was the only possible salvage option for giant angiosarcoma, which led to hemodynamic instability. Followed by chemotherapy, this radical approach may prolong survival.

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Section: Discussionmentioning

confidence: 98%

Surgical resection of a giant cardiac angiosarcoma and reconstruction of involved right heart structures: A case report

Blindaru

Vasilescu²,

Danet³

et al. 2023

Front. Cardiovasc. Med.

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“…Alternative strategies such as orthotopic heart transplantation in the patients with high-grade angiosarcomas, especially in young patients for whom we do not have other options, have also been explored (34). Chemotherapy, both neoadjuvant and adjuvant, is sometimes utilized to augment the poor outcome of resection alone (22,(29)(30)(31)35), or in cases which resection of the tumor is no feasible, long courses of chemotherapy with different agents might be helpful. For example, one center started chemotherapy with paclitaxel and bevacizumab for almost one year, which led to a decrease in tumor size, and nally pazobanib, ifosfamide, and doxorubicin were administered due to detection of pulmonary and liver metastasis (39).…”

Section: Case Presentationmentioning

confidence: 99%

“…The most prevalent symptoms were dyspnea, chest pain, tachycardia, pleural and pericardial effusion (7,(14)(15)(16)(17)(18)(19). There were also cases presented with left atrium mass (20,21), ascites (16), SVC involvement (8, 19,22,23), valvular complications (18, 20), tamponade and shock (24,25), involvement of coronary vessels (26, 27), or heart rhythm abnormalities (20). In our patient, a rupture in the atrial wall was discovered which was assumed to be the underlying cause for her symptoms.…”

Section: Case Presentationmentioning

confidence: 99%

“…Although not so common, radiation therapy has also been used in angiosarcomas, mainly in the setting of metastases (22,30,31,40). A young boy with angiosarcoma was managed using MR-guided radiotherapy and demonstrated acceptable tolerance and a stable disease for two months (41).…”

Section: Case Presentationmentioning

confidence: 99%

“…Most patients end up with recurrent disease and death even in case of complete tumor resection (43,44). The median survival is considered to be 6-12 months (45); however, there are reports of cases with longer survival rates and also better prognosis in cases with complete surgical resection or lack of metastasis on presentation (22,46,47). On the other hand, with heart transplantation, the mean survival rate could be about 12 months.…”

Section: Case Presentationmentioning

confidence: 99%

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Primary Cardiac Angiosarcoma With Pulmonary Metastasis in a Young Female: A Case Report and Review of Literature

Kordjazy

Taheri

Parkhideh

et al. 2022

Preprint

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Background: Sarcomas are the most prevalent type of malignant primary cardiac tumor. Clinical presentation differs according to the size and location of the tumor and involvement of other structures. Case presentation: In this article, we present a 38 years old lady as a case of primary cardiac angiosarcoma with a huge challenge in diagnosis and management of the disease. On the 4th of June 2020, she emergently presented to the hospital with the chief complaint of cough and tachypnea, diarrhea, and malaise, and a history of blunt chest trauma three weeks ago. Based on the presentation and transthoracic echocardiography which was compatible with cardiac tamponade, emergent pericardiocentesis was performed. The first imaging showed bilateral pleural effusion, pericardial effusion, and no significant parenchymal lung involvement, which was not compatible with rheumatologic diseases or COVID-19. Based on cardiac CT angiography and evidence of dye entrance to the peri-right atrial area, right atrial free wall rupture was suspected as the cause of the massive pericardial effusion. Following multidisciplinary consensus, she underwent cardiac surgery; in addition to the 3*3 cm right atrium free wall rupture repair, concomitant sampling from the lung nodules, lymph nodes, pericardium, and also the surrounding tissue of the right atrium ruptured defect was performed. Based on immunohistochemistry, the diagnosis was compatible with cardiac angiosarcoma with metastasis to the lung. Due to the advanced stage of the tumor, oncologists advised against chemotherapy or radiotherapy and she went through palliative care. Finally, after a 53-day ICU stay and due to right-sided heart failure, the patient unfortunately died. Conclusion: COVID-19 pandemic has brought diagnostic challenges regarding differentiating SARS-CoV-2 infection from other diagnostic entities. On the other hand, due to the rarity and fatality of primary cardiac angiosarcomas, early diagnosis and possible management seem crucial for prolonged survival. Involving cardiac angiosarcoma in the initial differential diagnosis could warrant timely diagnosis and assessment of various therapies for cure or palliative care.

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Use of a bovine pericardial patch angioplasty for completion of a complicated end to side anastomosis of a recipient vessel in the free flap reconstruction of a radiated wound: A case report

et al. 2022

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Soft tissue sarcomas treated by extensive surgical resection and adjuvant radiation can lead to large tissue deficits that require free flap repair. Significant radiation can further compromise vessels necessitating novel therapeutic approaches. We describe an 82‐year‐old man who presented with a posterior thigh sarcoma and underwent wide local tumor resection and immediate reconstruction with a microvascular free flap. Due to radiated recipient vessels, this case required bovine patch angioplasty as a conduit for end to side anastomosis. Initial resection and pathology revealed a large myxofibrosarcoma. Wide local resection and radiotherapy resulted in a large irradiated soft tissue defect of 26 x 15 x 4 cm with exposed, radiation damaged neurovascular structures, and a lack of available regional flap options. The planned free flap, a 30 x 8 cm skin island from the left latissimus dorsi muscle with end‐to‐side anastomosis to the popliteal artery was complicated by friability of the vessel wall and insufficient perfusion. Given the extent of resection and radiation, there were no alternative recipient vessels present within the field. A bovine pericardial patch angioplasty of 2.5 cm in length was performed to the diseased popliteal vessel and an end to side anastomosis was successfully performed between the thoracodorsal artery and the patch. Improved reperfusion of the free flap was noted immediately following anastomosis indicating completion of the anastomosis of our complicated recipient vessel. During the uncomplicated postoperative course, the flap had good perfusion with Doppler signals present, and incision sites intact at discharge from acute hospitalization. Recurrent sarcomas that have undergone extensive resection and radiotherapy pose significant reconstructive challenges. For defects that require free tissue reconstruction when there are limited options for healthy, recipient vessels, bovine pericardial patch angioplasty may act as a robust conduit for diseased vessels.

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A case of primary cardiac angiosarcoma with surgical resection and reconstruction

Cited by 6 publications

References 6 publications

Surgical resection of a giant cardiac angiosarcoma and reconstruction of involved right heart structures: A case report

Surgical resection of a giant cardiac angiosarcoma and reconstruction of involved right heart structures: A case report

Primary Cardiac Angiosarcoma With Pulmonary Metastasis in a Young Female: A Case Report and Review of Literature

Use of a bovine pericardial patch angioplasty for completion of a complicated end to side anastomosis of a recipient vessel in the free flap reconstruction of a radiated wound: A case report

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