Giant cardiac metastasis of myxoid liposarcoma causing cardiac tamponade; report of a case

We report a very rare case of cardiac metastasis of myxoid liposarcoma. A 55-year-old man presented with dyspnea. Two and a half years ago, he underwent resection of myxoid liposarcoma in the left thigh. Magnetic resonance imaging (MRI) revealed a giant tumor occupying the pericardiac cavity and pressing the heart and consequently causing cardiac tamponade. The patient underwent surgery through a left thoracotomy approach. The pericardiac cavity was filled with a giant tumor with a stalk from the right ventricle and 2 small nodules on the main pulmonary artery. He was relieved from the symptom: however, he had a recurrence of the tumor at the same site 5 months after the operation. He underwent surgery for the removal of the second tumor; however, he died 49 days after the operation. Although cardiac metastasis is a very rare condition, its awareness is essential for careful long-term follow-up for the early detection of a metastatic cardiac liposarcoma after the resection of the primary tumor.     

Pericardial metastasis of myxoid liposarcoma causing cardiac tamponade

Although myxoid liposarcoma often metastasizes to various organs, cardiac metastasis is rare. We present herein a rare case with pericardial metastasis of myxoid liposarcoma, which expanded the pericardial sac extraordinarily and required an emergency operation because of acute cardiac tamponade. We undertook a review of the English literature regarding liposarcoma.     

Aggressive invasive recurrence of a right atrial myxofibrosarcoma

A 58‐year‐old man presented with left‐sided chest discomfort 9 years ago. At that time a 12‐centimeter extrapleural mass was resected via left thoracotomy. Surgical pathology revealed a low‐grade myxofibrosarcoma. Since that time, he had undergone three separate resections of recurrent left extrapleural masses with sternotomy and thoracotomy. He proceeded to have a five‐year disease‐free interval after which a pericardial mass invading into the right atrial free wall, the atrioventricular groove, and the right coronary artery was identified. Surgical resection was performed with negative margins and the right atrium and atrioventricular groove were reconstructed without any residual tricuspid regurgitation.     

Myxoid liposarcoma of the ankle: a case report

Myxoid liposarcoma occurs predominantly in the deep soft tissues of the extremities, and tends to metastasize to a wide range of soft tissue or bone locations. We report a case of myxoid liposarcoma arising in the ankle of a 19-year-old man. A diagnosis of myxoid liposarcoma was made by open biopsy, and a wide resection requiring plastic surgical reconstruction was performed. Cytogenetic analysis of the resected tumor exhibited a reciprocal translocation t(12;16)(q13;p11) as the sole anomaly, which is found in more than 90% of myxoid liposarcoma cases. The patient had no evidence of local recurrence or metastasis within 7 years of follow-up. Although myxoid liposarcoma is rare in the ankle, it should be considered in the differential diagnosis of a painless soft tissue mass in this region.     

Primary Cardiac Liposarcoma Causing Cardiac Tamponade: Report of a Case

The intracardiac growth and extension of liposarcoma was observed in a 60-year-old woman. The epicardial tumor was identified to originate from the anterior wall of the right ventricle. She initially showed symptoms associated with cardiac tamponade. A surgical operation was performed but it resulted in incomplete resection due to massive invasion and dissemination. The recurrence of the tumors led to congestive heart failure. Finally, she died of heart failure and liver dysfunction as a result of tumor metastasis and invasion. An autopsy detected the primary cardiac liposarcoma. Only a few cases of cardiogenic liposarcoma have so far been reported. A further elucidation of cardiac liposarcoma could reveal mechanisms of the disease, and thus contribute to development of complementary therapies after surgical intervention.     

Cardiac liposarcoma at the right ventricular outflow tract (RVOT) following lipomatous hypertrophy of the interatrial septum (LHIS); report of a case

A 23-year-old man, presenting with a 10-year history of a cardiac lipoma (lipomatous hypertrophy of the interatrial septum: LHIS), complained of anterior chest discomfort. Echocardiography and magnetic resonance imaging revealed remarkable hypertrophy of the interatrial septum (IAS) and posterior wall of the right atrium (RA), massive pericardial adipose tissue, and mild aortic valve insufficiency caused by compression of the tumor on the right ventricular outflow tract (RVOT). We performed surgical resection of the tumor stemming from the RVOT following removal of a large amount of the pericardial fat tissue (1,794 g), and then undertook biopsies of the IAS and the posterior wall of the RA. Pathological examination showed the right ventricular (RV) tumor to be liposarcoma and confirmed the benign nature of the biopsy tissues. We herein report a rare case of cardiac liposarcoma following LHIS in a young patient.     

Modification of De Vega's Tricuspid Annuloplasty for Experimental Tricuspid Regurgitation

We propose a new experimental model of tricuspid annular dilatation and provide some modifications to De Vega's tricuspid annuloplasty to treat this condition. Tricuspid annular dilatation was done by creating ten 1.5-mm incisions around the circumference of the tricuspid annulus. The annulus became significantly dilated from 7.6 cm to 9.4 cm (p < 0.01). After dilatation, 2–0 polypropylene stitches were placed circumferentially around the tricuspid annulus and the suture ends were brought outside the heart through the right atrial wall. After cardiac resuscitation, the following hemodynamic variables were measured as preload was increased incrementally: mean right atrial pressure, v wave of atrial pressure, right ventricular end-diastolic pressure, and cardiac output. Measurements were obtained and preload-output curves were constructed for three time periods: before annular dilatation (Control); after dilatation, but before external adjustment (Before); and after external modification of the annulus (After). Following cardiac resuscitation, right atrial and ventricular pressures were significantly higher after annular dilatation, compared to control values. The preload-output curve was shifted to the right, and cardiac output could not be increased above 0.9 L/min. Once the extracardiac adjustment was accomplished, these pressures were returned to control values, and the preload-output relationship was returned to normal curve. (J Card Surg     

A case of successful surgical repair for congenital corrected transposition of the great arteries associated with Ebstein's malformation and diverticulum of atrialized ventricle

Congenital corrected transposition of the great arteries (C-TGA) is frequently associated with VSD and PS. Systemic atrioventricular valve regurgitation is also sometimes present in patients with C-TGA. It is though that left-sided A-V valve regurgitation is caused by the deformities of the tricuspid valve (TV) or intolerance of TV and the right ventricle (RV) against systemic pressure load. We had a patient with C-TGA associated with Ebstein's malformation. The patient suffered from congestive heart failure due to left-sided A-V valve regurgitation. In this case, the septal and posterior leaflets were displaced below the atrioventricular annulus. The edges of all valves were thickened and partially calcified. Focal agenesis was found in the septal leaflet. There was a distinct atrialized ventricle which had a thin wall and no trabeculae. It shaped like a diverticulum of 3 cm in depth toward the diaphragm. Preoperative cardiac catheterization showed that the functional RV had an adequate size (RVEDVI 162% of normal) and ejection fraction was 53%. Left-sided valve replacement was performed using SJM 31M with preservation of TV. Left-sided atrioventricular annulus was so deformed due to the diverticulum that the prosthetic valve was sutured at the ventricular wall below the atrioventricular annulus to which TV had attached. Good clinical result was obtained after surgical treatment.     

Successful surgical resection and reconstruction for a huge primary cardiac lymphoma filling the right heart

Primary cardiac lymphoma (PCL) is rare, with a frequency of 1.0%–1.6% among cardiac malignant tumors. Chemotherapy is often selected as a first‐line treatment for PCL. However, when the tumor causes heart failure or life‐threatening hemodynamic collapse, antecedent urgent surgery is required. We herein report a successful case of complete tumor resection and reconstruction of the right atrium and right ventricle using a bovine pericardial patch combined with tricuspid valve replacement in a patient with a huge PCL filling the right heart that manifested as tricuspid valve stenosis and subsequent heart failure.     

Liposarcoma of the breast,review of the literature and a report of a case

A case of gigantic liposarcoma of the breast in a 52-year-old woman was reported. She had a small indolent mass in the left breast for twenty years. The mass grew rapidly from the summer of 1979 and became gigantic and penetrated the skin over the mass. Her general condition on admission was poor but resection, of the tumor was carried out. She suddenly died of cardiac failure with electrolytes imbalance 13 days after the operation. The diagnoses of liposarcoma, predominantly myxoid, was made on the basis of light and electron microscopic findings. Forty cases of liposarcoma of the breast were collected from the literature. The possibility of malignant trans-formation of a benign tumor was suggested.     

Cardiac metastatic liposarcoma.

Metastatic cardiac liposarcoma is extremely rare, with only 2 cases previously reported, to our knowledge; of those, only 5 involved surgical resection of right ventricular liposarcoma. The first such case in Japan involved a 61-year-old woman with metastatic liposarcoma of the right ventricle. Despite emergency resection, the patient died of severe congestive heart failure 6 days after operation. Her history included surgery for liposarcoma in the right knee 11 years previously, although it is very difficult to predict that metastasis would proceed thereafter to the cardiac cavity. This rare case suggests, however, that follow-up including examination for cardiac lesions is necessary long after resection of the primary lesion.     

Three-dimensional imaging of mitral and tricuspid annuli for total artificial heart implantation

The establishment of a method to clarify the three-dimensional interrelations among the mitral annulus, tricuspid annulus, ascending aorta, and main pulmonary artery, which constitute the interface between the human and total artificial heart (TAH), is essential to the design of the TAH. In a previous study based on transverse magnetic resonance (MR) images of a live human heart, reconstructed images of mitral and tricuspid annuli were found to be deformed. The present study of cadaver and beating hearts revealed that the optimal conditions for atrioventricular annular reconstruction of a beating heart with electrocardiogram-gated MR imaging include use of four-chamber imaging, 5 mm slice thickness, and a slice interval ranging from 5 to 7 mm. Under these conditions, the mitral and tricuspid annuli of 3 beating hearts were reconstructed successfully. It was recognized that during the systolic phase the mitral and tricuspid annuli move anteriorly, leftward and downward, and that in late systole the right lateral margin of the tricuspid annulus is close to the sternum.     

Successful resection of recurrent mediastinal liposarcoma using preoperative evaluation of organ invasion by four-dimensional computed tomography

We report the case of a 64-year-old woman with recurrent mediastinal dedifferentiated liposarcoma. She had undergone surgical resection twice. Subsequently, on regular follow-up visits, chest computed tomography demonstrated a third local recurrence of the tumor with invasion into adjacent intrathoracic organs. Adhesion of the heart to the anterior chest wall through a pericardial defect that had been inadvertently created at the second operation was suspected. We decided to use a thoracoabdominal approach with four-dimensional computed tomography (4DCT) for preoperative guidance. The patient had also undergone MRI; however, the result was equivocal regarding adhesion of intrathoracic organs. The use of 4DCT enabled successful en bloc resection of the tumor. Results of the pathology examination showed complete resection of a dedifferentiated liposarcoma. The patient’s postoperative course was uneventful, and she was discharged on postoperative day 19.     

Liposarcoma in the epidural space

STUDY DESIGN: A patient with myxoid liposarcoma in the lumbar epidural space is reported. OBJECTIVE: The subject was treated with marginal resection and posterior instrumentation. SUMMARY OF THE BACKGROUND DATA: Liposarcoma is a malignant tumor of the soft tissues. It is commonly seen in the thigh. Lumbar extradural space is an unusual localization. Two cases have been reported with this localization in the literature. METHODS: The authors have treated a female patient with myxoid liposarcoma in lumbar extradural space with marginal resection and posterior instrumentation. RESULTS: The histopathologic examination showed myxoid liposarcoma. Two cases have been reported in the literature. CONCLUSION: Myxoid liposarcoma is a malignant tumor of the soft tissues. The extradural tumor was probably originated from the epidural fat tissue. Although wide resection is advised in the thigh localization, extradural localization of the tumor can be treated with marginal resection if there is no invasion to the surrounding tissue.     

Partial closure of the atrial septal primum defect and biventricular repair for a case of hypoplastic right ventricle with partial atrioventricular canal defect

An eight-year-old girl with partial atrioventricular canal defect and hypoplastic right ventricle was treated successfully by a palliative open-heart surgery. The preoperative right ventricular pressure was 58/7 mmHg (RVP/LVP = 0.67) and morphology of the right ventricle showed severe tricuspid stenosis and small outflow portion. The preoperative RVEDVI was 31 (41% of normal and tricuspid annulus was 17 mm (47% of normal). The right ventricular outflow was reconstructed with insertion of MVOP and the ASD was partially left open (the amplitude of the interatrial communication was 7 mm). Angiocardiogram two and half years after the operation demonstrated significant right ventricular growth with no right to left shunt through interatrial communication. The RVEDVI was 46 (56% of normal) and tricuspid annulus was 36 mm (90% of normal). This technique can be a procedure of choice in patient with right ventricular hypoplasia, who is not candidate for simple right ventricular reconstruction nor Fontan procedure, as the growth of the right ventricule is expected in the future.     

Angiosarcoma causing cardiac rupture

We report the 7th known case in the literature of cardiac angiosarcoma resulting in cardiac rupture. A 34-year-old woman was admitted presenting chest pain and pericardial effusion. After the patient had been treated for 3 months under the diagnosis of pericarditis of unknown etiology, she became hypotensive. Doppler echocardiography showed increased pericardial effusion and a communication between the right atrium and the pericardial cavity. An emergency operation was undertaken to drain the effusion and explore the etiology. We found the ruptured right atrium and the irregularly shaped tumor extending from the pericardium near the inferior caval vein to the right ventricle. There was no apparent tumor on the right atrium, but its wall was extensively thin, which we replaced with autologous pericardium. The patient died on the 44th postoperative day. Clinical diagnosis of cardiac angiosarcoma is usually very difficult. If Doppler echocardiography demonstrates pericardial effusion and find a ruptured right atrium with or without mass formation, we should suspect cardiac angiosarcoma.     

Lack of effect of synthetic pericardial substitute on right ventricular function after coronary artery bypass surgery. An echocardiographic and magnetic resonance imaging study

Abnormal right heart function after cardiac surgery is a well-known finding. Inadequate preservation during the operation and restricted cardiac motion due to pericardial adhesions have been proposed as underlying mechanisms. This study focuses on the impact of a pericardial substitute implantation on right ventricular function, using echocardiography and magnetic resonance imaging. A test group of six patients (mean age 54 years) was examined before surgery, and 4-15 days and 5-9 months after coronary artery bypass surgery, where the pericardium was closed with a biodegradable pericardial patch. A group of 11 patients (mean age 63 years) in whom the pericardium was left open served as controls. Tricuspid annulus motion was markedly decreased, abnormal septal motion was present and decreased systolic to diastolic ratio in the vena cava superior flow was present in all patients in both groups one week after surgery. At the late follow-up, all patients still had decreased tricuspid annulus motion, while 17% of the patients in the test group and 22% of the patients in the control group (ns) demonstrated normal septal motion. We conclude that closing the pericardium with a biodegradable patch does not affect the postoperative changes in right heart function normally seen after open-heart surgery.     

Tricuspid valve replacement in the true annulus of Ebstein's anomaly without involvement of atrioventricular conduction disturbance

Two female patients with Ebstein's anomaly, aged 12 and 45 years, underwent new procedures of tricuspid valve replacement in the true annulus without involvement of atrioventricular conduction disturbance. The first patient had a relatively small atrialized right ventricle. A Dacron patch was sutured on the atrialized portion from the right ventricular side. Buttress stitches were placed on the whole of the atrialized ventricle except at the part of the His' bundle. A porcine valve was sutured in the true annulus of the tricuspid valve and on the top of the patch. The second patient had a fairly large atrialized ventricle, and plication was made only in the inferior part of the atrialized ventricle form the coronary sinus. A porcine valve was sutured in the true tricuspid annulus except at the part of Koch's triangle, where the porcine valve was placed on the false annulus.     

Giant primary liposarcoma of the chest

Liposarcomas are the most common soft tissue sarcomas in adults, although liposarcomas of the chest are uncommon. We report two cases of giant liposarcoma in the mediastinum and chest wall, respectively. An 82-year-old man presented with a mass in the right upper mediastinum, as seen by computed tomography (CT). He had a past history of subcutaneous lipoma resection on his back (19 years previously). The patient underwent tumor resection with a right thoracotomy. A 58-year-old woman presented with an enlarging mass of the right lateral chest, involving the diaphragm and ribs, as seen by CT. She had a past history of subcutaneous lipoma resection of the right chest (18 years previously). The patient underwent an en bloc resection that included the tumor and a part of the right diaphragm and ribs. Histological examination of both patients’ tumors revealed a well-differentiated liposarcoma, with no pathological relation to the previous lipoma resected in either case.     

Successful resection of cardiac metastatic liposarcoma extending into the SVC, right atrium, and right ventricle

Cardiac metastatic liposarcoma is a rare tumor. We report a case of successful resection of a cardiac metastatic liposarcoma extending into the superior vena cava (SVC), right atrium, and right ventricle. Using cardiopulmonary bypass (CPB) by venous cannulation of the upper portion of the SVC and inferior vena cava (IVC), the intracardiac tumor was completely resected. Surgical resection with the addition of radiotherapy prolonged the patient's life.