Surgical excision of metastatic malignant melanoma involving the tricuspid valve

Abstract

Malignant melanoma is unique in terms of its high incidence of metastases to the heart, ranging from 50-71% in autopsy studies. The high incidence of cardiac melanomas is largely a manifestation of the tumour's propensity to metastasise widely before causing death. Malignant melanoma can involve any and all chambers of the heart. Isolated metastases can occur; however, more commonly, the metastases are extensive with pericardial, myocardial and endocardial involvement. Pure endocardial involvement and valvular involvement is rare. Melanoma is more likely to be present in the right heart chambers. 1Once cardiac metastases from melanoma are identified, the patient usually has widely disseminated disease and rarely is treatable with operation. 1 We recently resected a large intracardiac metastatic malignant melanoma, straddling the tricuspid valve, along with tricuspid valve replacement and coronary bypass grafting. This is the first report describing a metastatic melanoma infiltrating the tricuspid valve with successful surgical excision. Case reportAn 83-year-old man was detected to have a systolic murmur during routine check-up. Previously, he had undergone excision of a right shoulder malignant melanoma lesion (Clark level 4), 9 years previously, and An 83-year-old man presented with a large intracavitatory metastatic malignant melanoma, infiltrating the anterior leaflet of the tricuspid valve. The tumour was excised completely along with the anterior leaflet of the tricuspid valve which was replaced. The patient was well 2 months after surgery.

Surgical experience with right ventricular tumors in 17 patients

“…19,[24][25][26] Most patients who undergo tricuspid repair have endocardial tumors 8,10,[13][14][15][16][17][18]23 ; few have epicardial tumors. 9 The endocardial tumors reported were 40-610 mm in maximum diameter in adults (n = 6; median 80 mm), 10,[3][4][5][6][7][8][9][10][11][12][13][14][15]17,23 with the exception of cases with tumor adherent to the tricuspid valve leafl et (25-30 mm diameter) 16,18 or tumors arising from the papillary muscle of the tricuspid valve without tricuspid valve involvement (12 mm diameter).…”