J Korean Med Sci.  2013 May;28(5):717-724. 10.3346/jkms.2013.28.5.717.

Clinical Implication of Surgical Resection for the Rare Cardiac Tumors Involving Heart and Great Vessels

• Oh SJ
• Yeom SY
• Kim KH

• KMID: 1777559
• DOI: http://doi.org/10.3346/jkms.2013.28.5.717

Abstract

This study aimed to investigate the clinical implication of surgical resection for the malignancies of heart and great vessels. Between January 2001 and May 2011, a retrospective review of the results in 12 patients was conducted. There were 6 patients with primary cardiac tumor including leiomyosarcoma, angiosarcoma, undifferentiated type sarcoma and malignant fibrous histiocytoma. The remaining 6 patients had the metastatic tumors or adjacent invasion to the heart and great vessels. Six of seven patients who underwent complete resection had no evidence of recurrence. However, four of five patients who underwent incomplete resection or biopsy showed local recurrence or distant metastasis of residual tumor, and one of them required reoperation for recurred tumor. In-hospital mortality was 8.3% and the mean survival of all patients was 22.2 +/- 6.1 months. Survival of the incomplete resection group, except for the two biopsy cases, was 25.9 +/- 7.9 months, and there was no mortality in the complete resection group. Therefore, clinical outcomes in patients who had malignancies of the heart and great vessels may be improved when the aggressive and complete resection, or possible debulking for palliation, was performed. Moreover, adjuvant multimodality therapy may be imperative to prevent recurrence or metastasis, and to provide improved survival.

Keyword

Cardiac Tumors (Primary, Metastatic); Sarcoma; Adjuvant Therapy

MeSH Terms

Adult
Aged
Female
Follow-Up Studies
Heart Neoplasms/mortality/pathology/*surgery
Humans
Intensive Care Units
Kaplan-Meier Estimate
Length of Stay
Magnetic Resonance Imaging
Male
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Retrospective Studies
Sarcoma/mortality/pathology/*surgery
Tomography, X-Ray Computed

Figure

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  Fig. 1 Intraoperative findings and surgical resection. (A) This picture shows the metastatic tumor originated from colon cancer which involved the LA and right lung. The tumor causes the obstruction of mitral valve (arrow). (B) En bloc tumor resection with intra-pericardial bilobectomy of right middle and lower lobe, LA plasty with glutaraldehyde (GA)-fixed autologous pericardial patch, mediastinal lymph node dissection. (C) Mediastinal mass involves the distal ascending aorta, total arch and arch vessels, superior vena cava, and innominate vein. Resection of superior vena cava (SVC) invasion (arrow). (D) Replacement of the ascending aorta and total arch with 18 mm vascular graft, and separate replacement of arch vessels using 12-8-8 mm Y-Yed graft (Spielvogel technique). SVC reconstruction with GA-fixed autologous pericardium (arrow).

• 

  Fig. 2 Kaplan-Meier survival curves for the overall survival rate for all patients with malignant tumor of the heart and great vessels.

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  Fig. 3 Preoperative cardiac MRI and intraoperative findings of malignant cardiac tumor. (A) Well enhancing 4.8-cm size broad based mass in left atrium (LA) and interatrial septum extending to orifice of left lower pulmonary vein. (B) Tumor involvement to mitral valve anterior leaflet (arrow). (C) SVC transection with RA retraction, and LA roof approach for full exposure of mass: Broad based, 5×3 cm sized, multilobulating, large LA mass occupied the LA cavity including posterior and inferior wall, and invaded the mitral valve leaflet.

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