Radical Resection Using the Commando Procedure for Recurrent Cardiac Intimal Sarcoma in a Young Adult: A Case Report

Primary cardiac intimal sarcoma is an extremely rare, high-grade malignancy characterized by rapid progression and high early recurrence rates. We report the case of a 28-year-old male who underwent emergency resection for a large left atrial intimal sarcoma (10 × 8 cm). Follow-up imaging at 6 months revealed a 15-mm recurrent tumor infiltrating the left atrial septum, despite an initially stable recovery. We prioritized radical resection over surgical risk, given the patient's youth and the aggressive behavior of the tumor. Therefore, a "Commando" procedure consisting of radical tumor resection, double valve replacement, and reconstruction of the intervalvular fibrosa using the Manouguian technique was performed. Histopathological examination confirmed recurrent intimal sarcoma with negative surgical margins. Despite its high invasiveness, the Commando procedure is viable for primary treatment for recurrent cardiac intimal sarcomas in young patients. Aggressive surgical reconstruction remains the only viable option to improve the prognosis of this otherwise fatal malignancy.