Near Total Occlusion of Right Ventricle by Cardiac Mass

Abstract

The incidence of primary cardiac tumors is very rare (0.02%) with the majority being benign. Angiosarcoma is the most common malignant cardiac tumor. However, regardless of the histological nature of cardiac tumors, they can cause life-threatening mechanical obstruction. We present a case of urgent surgical removal of a right ventricular (RV) mass. Echocardiography was instrumental for confirmation of the diagnosis, delineation of the anatomical extent of the tumor, evaluation for associated structural involvement and assessment of repair along with constant hemodynamic monitoring.

Ethical and clinical dilemma from an incidental cardiac lipoma in a young and healthy patient

“…Primary cardiac tumor perse is extremely rare. [ 1 2 ] Most of the primary cardiac tumors are benign. Based on the origin, location, type and size of the tumor, patient's symptoms, and sign can vary from none to arrythmia, heart failure, embolization, and obstructive valvulopathy.…”

“…Multiple imaging modalities that carry significant value in diagnosis include but not limited to echocardiography, CT, MRI, and positron emission tomography scan. [ 1 4 ] Histopathology of the biopsy finally can conclusively prove the diagnosis. However, cardiac biopsy is an invasive procedure and should only be attempted after exhausting all other noninvasive modalities and/or when a decision has been made to proceed with surgical resection.…”

“…Primary cardiac tumor is very rare (0.02–0.05%). [ 1 2 ] Fortunately, majority of primary cardiac tumors are benign, myxoma being the most common. Depending on the origin and location of the cardiac tumor, symptoms and signs can be of varieties, for example, palpitation, heart failure, embolization, and valvular stenosis.…”

Making the Rare Diagnosis: Trust Yourself, Your Colleagues, or Both?

“…6,9 It is unlikely that in the case presented by Mondal et al that the surgical intervention provided a substantial increase in survival given the extent of disease. 1 This case reminds us of the multidisciplinary collaboration necessary to provide patients with the best possible care, which inevitably will lead to better outcomes. In the case described by Mondal et al, the information provided by the cardiac anesthesia team, specifically through the use of transesophageal echocardiography, was instrumental in guiding the surgical decision making algorithm intraoperatively.…”

Following the written path -- a patient's journey to finding care!

“…That is when he came across my previous article 'Near Total Occlusion of Right Ventricle by Cardiac Mass ' which was published at Journal of Cardiothoracic and Vascular Anesthesia (JCVA) and knowing that we both are geographically from the same state (MD), he emailed me if I can connect him with some cardiothoracic (CT) surgery experts (Figure 1). [2] I was very surprised to receive that request however, I suggested him few of the renowned CT surgeons who are well known for cardiac tumor surgery at my institutions. Few weeks later, he was scheduled for surgical resection of the cardiac tumor with one of the surgeons, I recommended and oddly enough, I was assigned to be his CT anesthesiologist.…”