Transvenous biopsy of a right atrial tumor under transesophageal echocardiographic guidance

Azuma, Teruhito; Ohira, Akiko; Akagi, Hideharu; Yamamoto, Tadao; Tanaka, Tomoyuki

doi:10.1016/s0002-8703(96)90375-0

Cited by 16 publications

(10 citation statements)

References 4 publications

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“…The pathology can be established by transvenous [23][24][25] or transthoracic biopsy with ultrasound guidance [26], especially with right heart tumours. Echo guided transvenous tumour biopsy can be complicated by tumour embolism.…”

Section: Lymphomamentioning

confidence: 99%

Primary cardiac sarcoma

Shanmugam¹

2006

European Journal of Cardio-Thoracic Surgery

132

157

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Primary malignant lesions of the heart are rare. Although myxomas have been extensively described, there is a paucity of large studies on non-myxomatous cardiac tumours. On the other hand, there are several case reports on specific histopathological variants, in small numbers. Consequently there exists no consensus on therapeutic modalities for cardiac sarcomas. The prognosis for these lesions remains dismal, despite the enhanced diagnostic ability of newer technology. The reasons for the dismal prognosis are (1) the advanced tumour stage at presentation, (2) non-specific symptomatolgy, (3) insufficient awareness of these lesions, due to their rarity, (4) delayed diagnosis and/or misdiagnosis, which leads to (5) advanced tumour stage at presentation. Thus a vicious cycle is created. This article addresses these issues, deals with the surgically relevant modes of presentation, rather than the histopathology, and reviews the diagnosis and management options for the various sarcomas, categorized by the site and extent of cardiac involvement. Clinicians should be familiar with the presentation of these tumours and have a high index of suspicion, since the potential for long-term survival following resection does exist. Wide surgical resection remains the cornerstone of sarcoma therapy. Complete characterization of tumour extent using echocardiography and CT/MRI is mandatory to achieve this goal. Radical resections such as 'bench surgery' and transplantation may reduce local recurrence, but the risk of metastatic disease remains. The clinical experience with such approaches is limited. The role of adjuvant therapy is not yet established. In no other field of cardiac surgery would a multidisciplinary approach be more useful, in achieving cure or long-term palliation.

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Section: Lymphomamentioning

confidence: 99%

Primary cardiac sarcoma

Shanmugam¹

2006

European Journal of Cardio-Thoracic Surgery

132

157

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“…There have been reports of transvenous biopsy for cardiac tumors under transesophageal echocardiography (TEE) guidance, [4][5][6][7] although sometimes specimen material is not successfully obtained.…”

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confidence: 99%

Cardiac Angiosarcoma Diagnosed by Transvenous Endomyocardial Biopsy With the Aid of Transesophageal Echocardiography and Intra-Procedural Consultation

et al. 2010

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SummaryWe report a case who had confirmed tumor cells in the biopsy specimens by transvenous endomyocardial biopsy with intra-procedural consultation and fast smear cytology. A 57-year-old female was admitted to our hospital because of shortness of breath and left back pain. Transthoracic echocardiography (TTE) and contrast-enhanced computed tomography (CT) scans demonstrated a large mass in the right atrium and multiple liver tumors thought to be due to spread of the disease. Coronary angiography showed the right coronary artery was involved in the mass. In order to confirm the histological diagnosis, we attempted transvenous endomyocardial tumor biopsy under fluoroscopic guidance. However, we failed to obtain adequate tissue material. Due to several risks associated with a surgical procedure such as an open surgical biopsy, transvenous endomyocardial tumor biopsy was again attempted with the aid of transesophageal echocardiography (TEE). Intra-procedural consultation and fast smear cytology enabled us to finish the procedure. Hematoxylineosin stained sections demonstrated spindle-shaped cells. Immunohistochemical stains of these cells were positive for anti-factor VIII antigen, CD31, and CD34. These findings indicated a definite diagnosis of angiosarcoma. Since there was no surgical indication for this tumor, the patient underwent chemotherapy with docetaxel and radiotherapy. Three months later, CT scans showed a reduction in the size of the cardiac tumor. (Int Heart J 2010; 51: 367-369) Key words: Primary cardiac angiosarcoma, Transvenous endomyocardial biopsy, Transesophageal echocardiography, Intra-procedural consultation, Smear cytology P rimary cardiac tumors are extremely rare and difficult to diagnose. A final diagnosis depends on histopathological confirmation. At the time of discovery, up to 75% have systemic metastases 1) and the effect of surgical resection is only temporary, 2) and hence the prognosis is relatively poor. A pathological diagnosis with cardiac biopsy is established antemorten in only 50% of patients.3) The specimen material is usually obtained by open biopsy or surgical resection. There have been reports of transvenous biopsy for cardiac tumors under transesophageal echocardiography (TEE) guidance, 4-7) although sometimes specimen material is not successfully obtained. 8) Case ReportA 57-year-old woman was admitted to our hospital because of shortness of breath and left back pain. She had been healthy previously without recent chest pain or pyrexia, and she denied any exposure to vinyl chloride. On physical examination, her heart rate was 94/minute, blood pressure was 90/54 mmHg, and SpO 2 was 98% with a 10 L/minute O 2 . Jugular vein dilatation and hepatomegaly were detected. Neither heart murmur nor lung rales were detected. The electrocardiogram showed sinus tachycardia (94 beats/minute), low voltage in limb leads, and a QS pattern in V 1 and V 2 leads. Chest X-rays revealed cardiomegaly and bilateral pleural effusion. Transthoracic echocardiography (TTE) showed reasonable left ve...

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“…Previous reports demonstrate that a transvenous EMB procedure under fluoroscopic guidance is safe when performed by experienced technicians, the overall rate of complications is between 1% and 3%, the risk of cardiac perforation with tapenade is less than 0.05% (12,13). A transvenous EMB procedure under TEE guidance is a useful, simple and safe method (14)(15)(16)(17)(18)(19). However, it causes patient discomfort and sometimes requires general anesthesia in addition to local pharyngeal anesthesia.…”

Section: Figure 2 Contrast Computed Tomographic Imaging (A) and Magnmentioning

confidence: 99%

Diffuse Large B-cell Lymphoma Diagnosed by Intracardiac Echocardiography-guided Cardiac Tumor Biopsy

et al. 2012

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A 44-year-old man presented with exertional dyspnea. Transthoracic echocardiography (TTE) revealed a large tumor protruding into the right atrium and extending into the left ventricle. Cardiac magnetic resonance imaging and contrast enhanced computed tomography also confirmed the intracardiac tumor detected by TTE. An endomyocardial biopsy was performed under the intracardiac echocardiography (ICE) guidance, and he was diagnosed to have diffuse large B-cell lymphoma following the histological analysis. ICE-guided cardiac tumor biopsy is expected to be a useful diagnostic strategy that can minimize the risk of procedural complications.

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Transvenous biopsy of a right atrial tumor under transesophageal echocardiographic guidance

Cited by 16 publications

References 4 publications

Primary cardiac sarcoma

Primary cardiac sarcoma

Cardiac Angiosarcoma Diagnosed by Transvenous Endomyocardial Biopsy With the Aid of Transesophageal Echocardiography and Intra-Procedural Consultation

Diffuse Large B-cell Lymphoma Diagnosed by Intracardiac Echocardiography-guided Cardiac Tumor Biopsy

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