ABSTRACT
Melanoma has a known propensity for cardiac metastasis. Most cases are associated with widespread metastatic disease and multiple sites of cardiac involvement and are not appropriate for surgical resection. When there is an isolated metastasis to the heart, the melanoma tends to involve the right heart. Rarely does melanoma metastasize only to the left ventricle. We present an unusual case of isolated metastasis of melanoma to the intracavitary left ventricle. This tumor was poorly responsive to chemotherapy, and a cardiac autotransplantation technique was used to achieve complete resection with pathologically negative margins.
Subject(s)
Cardiac Surgical Procedures/methods , Heart Neoplasms/secondary , Heart Neoplasms/surgery , Melanoma/secondary , Melanoma/surgery , Replantation , Skin Neoplasms/pathology , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chemotherapy, Adjuvant , Heart Ventricles/pathology , Heart Ventricles/surgery , Humans , Lymphatic Metastasis , Magnetic Resonance Imaging , Male , Middle Aged , Tomography, X-Ray Computed , Transplantation, Autologous , Treatment OutcomeABSTRACT
Cardiac fibroma is a rare, benign tumor that occurs chiefly in children and rarely in adults. Most fibromas occur in the ventricles and may reach a very large size that complicates surgical removal. Herein, we report the case of a 38-year-old woman who presented with shortness of breath, fatigue, and lightheadedness and was found to have a 6 × 8-cm fibroma of the left ventricle. Surgical resection was successful, but 7 days later she developed sudden-onset severe mitral regurgitation due to partial disruption of the posterolateral papillary muscle. Mitral valve replacement with a 27-mm mechanical valve was performed. Five years later, the patient remained well, without evident tumor recurrence or cardiac dysfunction.Mitral valve dysfunction with regurgitation has been reported to occur before, immediately after, and late after the resection of left ventricular fibromas. To our knowledge, this is the 1st report of subacute papillary muscle rupture after the resection of a left ventricular fibroma. This case highlights the need to evaluate mitral valve function by carefully inspecting the resection margins after surgery and interpreting the echocardiographic results during the acute, subacute, and late time frames.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Fibroma/surgery , Heart Neoplasms/surgery , Heart Rupture/surgery , Heart Valve Prosthesis Implantation , Mitral Valve Insufficiency/surgery , Papillary Muscles/surgery , Adult , Female , Fibroma/pathology , Heart Neoplasms/pathology , Heart Rupture/diagnostic imaging , Heart Rupture/etiology , Heart Ventricles/pathology , Heart Ventricles/surgery , Humans , Magnetic Resonance Imaging , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/etiology , Papillary Muscles/diagnostic imaging , Reoperation , Severity of Illness Index , Treatment Outcome , UltrasonographyABSTRACT
Infection after aortic root replacement is uncommon, and it can be fatal. Herein, we present the case of a patient who underwent aortic root replacement with a valved conduit and coronary reimplantation. Prosthetic valve endocarditis and left ventricular cutaneous fistula ensued. Either condition alone could have been fatal. The fistula coursed from the valved conduit through the left ventricular outflow tract, behind the left main coronary artery, and to the skin at the upper sternum. Safe surgical entry into the chest was crucial, due to the free communication between the left ventricle, mediastinum, and skin. We discuss our surgical approach to this unusual combination of conditions, and the postoperative treatment of the patient.
