RESUMO
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.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Neoplasias Cardíacas/secundário , Neoplasias Cardíacas/cirurgia , Melanoma/secundário , Melanoma/cirurgia , Reimplante , Neoplasias Cutâneas/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Ventrículos do Coração/patologia , Ventrículos do Coração/cirurgia , Humanos , Metástase Linfática , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Transplante Autólogo , Resultado do TratamentoRESUMO
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.
Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Fibroma/cirurgia , Neoplasias Cardíacas/cirurgia , Ruptura Cardíaca/cirurgia , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral/cirurgia , Músculos Papilares/cirurgia , Adulto , Feminino , Fibroma/patologia , Neoplasias Cardíacas/patologia , Ruptura Cardíaca/diagnóstico por imagem , Ruptura Cardíaca/etiologia , Ventrículos do Coração/patologia , Ventrículos do Coração/cirurgia , Humanos , Imageamento por Ressonância Magnética , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Músculos Papilares/diagnóstico por imagem , Reoperação , Índice de Gravidade de Doença , Resultado do Tratamento , UltrassonografiaRESUMO
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.
