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Percutaneous Intracardiac Mass Extraction in High Surgical-Risk Patients
Mariam Riad1, Mustafeez Ur Rahman1, Rajasekhar Mulyala1
1Cardiology Division, University of South Alabama, Mobile, AL 36617, USA.
Insights
Percutaneous removal successfully extracted a large right atrial mass in a patient with high surgical risk. This minimally invasive approach offers a viable alternative to open heart surgery for intracardiac masses.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Intracardiac masses pose significant embolic and obstructive risks.
- Open heart surgery is often contraindicated in patients with prohibitive surgical risk due to comorbidities.
- Percutaneous techniques are emerging as a viable alternative for intracardiac mass extraction.
Observation:
- A 42-year-old female with advanced liver cirrhosis and variceal bleeding presented with symptoms suggestive of infection.
- Blood cultures revealed Candida albicans, and echocardiography identified a mobile 1.0 x 3.0 cm right atrial mass.
- The patient had a prohibitive risk for open heart surgery.
Findings:
- Successful percutaneous removal of the right atrial mass was achieved using the Penumbra system.
- The patient's condition was managed without traditional open heart surgery.
- This case highlights the feasibility of percutaneous extraction for intracardiac masses in high-risk patients.
Implications:
- Percutaneous intracardiac mass removal is a safe and effective alternative for high-risk patients.
- Minimally invasive techniques can significantly reduce morbidity and mortality associated with intracardiac mass management.
- Further research and case studies are warranted to establish percutaneous extraction as a standard treatment option.
Abstract:
Large intracardiac masses including tumors, thrombi, and vegetations result in detrimental embolic or obstructive sequelae and present a management dilemma. Open heart surgery, the traditional approach, may not be an option for many patients with a prohibitive surgical risk due to multiple comorbidities. Recently, percutaneous options have emerged with reported success in extracting such intracardiac masses. A 42-year-old female with history of advanced primary sclerosing cholangitis with decompensated liver cirrhosis causing ascites and variceal bleed presented to the emergency department with fatigue, subjective fevers, chills and melena. Laboratory results revealed neutrophil-predominant leukocytosis and normocytic anemia, and blood cultures were positive for Candida albicans. Electrocardiography showed sinus tachycardia. Chest X-ray was unremarkable. She underwent packed red blood cell transfusion and esophageal banding for variceal bleeding. Transthoracic echocardiogram revealed normal left ventricular ejection fraction and no wall motion abnormalities. A right atrial mobile mass measuring approximately 1.0 × 3.0 cm was noted. Multidisciplinary heart team discussion concluded that while the mass posed a high embolic risk, the patient had a prohibitive risk for surgical intervention. Successful percutaneous removal of the mass using Penumbra system device (Penumbra Incorporated, Alameda, CA) was accomplished. This case report details the procedure and outcomes, as well as presents a literature review.
