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Resection of primary cardiac angiosarcoma infiltrating the right atrioventricular junction and tricuspid valve: a
Lubna Bakr1, Hussam AlKhalaf2, Ahmad Takriti2
1Department of Cardiac Surgery, Faculty of Medicine, Damascus University, Damascus, Syria. lubna-bakr@hotmail.com.
Insights
Primary cardiac angiosarcoma is rare and aggressive. This case shows surgical resection combined with adjuvant therapy is feasible for advanced tumors, offering a survival of over one year.
Area of Science:
- Cardiovascular Pathology
- Surgical Oncology
Background:
- Primary cardiac tumors are rare, with sarcomas comprising 95% of malignant cases.
- Primary cardiac angiosarcoma has a poor prognosis, often complicated by extensive tumor infiltration.
- This report details a case of cardiac angiosarcoma involving the right atrium and ventricle.
Observation:
- A 22-year-old male presented with dyspnea and recurrent pericardial effusion.
- Echocardiography revealed large masses in the right atrium and ventricle, impacting the tricuspid valve.
- Complete tumor resection was not possible; debulking surgery was performed, followed by reconstruction with heterologous pericardium.
Findings:
- Histopathology confirmed angiosarcoma; residual tumor was noted post-surgery.
- The patient received adjuvant chemotherapy and radiotherapy.
- Survival was 1 year and 5 days, with subsequent metastases leading to death.
Implications:
- Multimodal treatment, including surgery and adjuvant therapies, can be considered for advanced cardiac angiosarcoma.
- Even incomplete resection may offer survival benefits in select cases.
- Further research into novel therapeutic strategies for cardiac angiosarcoma is warranted.
Background:
Primary cardiac tumours are extremely rare. Most of them are benign. Sarcomas account for 95% of the malignant tumours. Prognosis of primary cardiac angiosarcoma remains poor. Complete surgical resection is oftentimes hampered when there is extensive tumour involvement into important cardiac apparatus. We report a case of cardiac angiosarcoma of the right atrium and ventricle, infiltrating the right atrioventricular junction and tricuspid valve.
Case Presentation:
Initially, a 22-year-old man presented with dyspnoea. One year later, he had recurrent pericardial effusion. Afterwards, echocardiography revealed a large mass in the right atrium, expanding from the roof of the right atrium to the tricuspid valve. The mass was causing compression on the tricuspid valve, and another mass was seen in the right ventricle. Complete resection of the tumour was impossible. The mass was resected with the biggest possible margins. The right atrium was reconstructed using heterologous pericardium. The patient's postoperative course was uneventful. Postoperative echocardiography showed a small mass remaining in the right side of the heart. Histopathology and immunohistochemistry confirmed the diagnosis of angiosarcoma. The patient underwent adjuvant chemotherapy and radiotherapy later on. He survived for 1 year and 5 days after the surgery. After a diagnosis of lung and brain metastases, he ended up on mechanical ventilation for 48 h and died.
Conclusions:
Surgical resection combined with postoperative chemotherapy and radiotherapy is feasible even in patients with an advanced stage of cardiac angiosarcoma when it is impossible to perform complete surgical resection.
