Author + information
- Received January 24, 2013
- Accepted February 15, 2013
- Published online June 1, 2013.
- María Cristina González-Cambeiro, MD∗∗ (, )
- Diego López-Otero, MD∗,
- José Rubio-García, MD†,
- Alejandro Virgós-Lamela, MD∗,
- Marino Vega-Fernández, MD∗,
- Ramiro Trillo-Nouche, MD∗ and
- José Ramón González-Juanatey, MD∗
- ∗Department of Cardiology and Coronary Unit, Universitary Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- †Department of Cardiovascular Surgery, Universitary Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- ↵∗Reprint requests and correspondence:
Dr. María Cristina González-Cambeiro, Cardiology Department and Coronary Unit, Universitary Clinical Hospital of Santiago de Compostela, Street Choupana, 15706 Santiago de Compostela, Spain.
A 32-year-old man presented with a primary angiosarcoma of the right atrium, which debuted with palpitations and febrile syndrome, with disseminated bone metastases at the time of diagnosis.
The presumptive diagnosis was established by imaging techniques (echocardiography and cardiac magnetic resonance). These images indicated the presence of a mass of 5 × 3 cm, with infiltrative aspect, attached to the lateral wall of the right atrium and the tricuspid annulus, with medium density and a possible hematic-necrotic component, causing pericardial fat and atrioventricular groove infiltration and encompassing the right coronary artery. Also, the presence of a moderate pericardial effusion, without hemodynamic compromise data, was described in the echocardiogram (Fig. 1).
In a coronary angiography, an extensive microvascular feeder grid was identified emerging through the proximal and medium right coronary artery segments, which was also compressed at this level (Fig. 2A).
After an incomplete mass resection and closure of the right atrial wall by a bovine pericardium implantation, the presence of a continuous arterial bleeding into the pericardial cavity was shown, from the remaining tumor, with ineffective surgical hemostasis methods. For this reason, we decided to perform urgent coronary angiography, which evidenced a significant extravasation of contrast from the right coronary artery to the pericardial cavity (Fig. 2B).
We proceeded to occlude the tumor microvasculature by implanting 5 overlapping polytetrafluoroethylene-covered stents from proximal to distal segment, thus excluding the bleeding area (Figs. 3A, 3B, and 4). Subsequently, the patient had a favorable outcome, and left the recovery unit at an early. Finally, he underwent 4 cycles of anthracycline-like palliative chemotherapy. Eight months after neoplasia treatment, the patient remains free of symptoms with stability in local and systemic disease.
The implantation of polytetrafluoroethylene-covered coronary stent after resection of cardiac tumor with feeder grid emerging from coronary arteries may be an effective measure to treat bleeding caused by the remaining tumor.
All the authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 24, 2013.
- Accepted February 15, 2013.
- American College of Cardiology Foundation