Cardiac Autotransplantation for Removal of Left Atrial Hemangioma and a Review of the Literature

  • Dimitri Novitzky
  • Maya Guglin
  • Cedric Sheffield

Abstract

We describe the management of a patient who presented with symptoms of severe congestive heart failure. A 48-year-old man was initially seen in the emergency room, admitted to the hospital, and worked up with a transthoracic echocardiogram, a transesophageal echocardiogram, and a computer tomography scan of the chest. All cardiac valves were normal, as was the left ventricular ejection fraction. A mobile left atrial tumor measuring 6 × 4 × 5 cm was found attached to the left atrial dome, left atrial cuff, and left pulmonary veins. With each systolic atrial contraction, the mass prolapsed into the left ventricle across the mitral valve annulus, inducing a gradient of 19 mm Hg. The workup of the patient was negative for malignancy. The only feasible therapy for this patient was to excise the mass on cardiopulmonary bypass and cardioplegic arrest. At the time of surgery, the findings confirmed that the mass was attached broadly to the left atrial dome wall-epicardium, and the attachments were similar to those of the transesophageal echocardiographic findings. Atrial attachments extended from the base of the heart, along the atrioventricular groove, the left dome of the left atrium, the left atrial cuff, and the anterior aspect of both left pulmonary veins. The tumor could not be adequately excised, and reconstruction of the defect was not feasible with the heart in situ. We therefore decided to explant the heart and excise the tumor with a 0.5-cm margin of healthy tissue. The broad left atrial defect was reconstructed with bovine pericardium. The reconstruction encompassed the dome of the left atrium, the left atrial cuff, and the pulmonary veins. The heart was reimplanted back into the pericardial cavity. The superior vena cava with the retained sinus node was also anastomosed. The pathology diagnosis was a benign cavernous hemangioma. The sinus rhythm recovered following removal of the aortic cross-clamp and reperfusion of the heart. The patient had a rapid recovery and was discharged home on the 12th postoperative day. Placement of a pacemaker was not required because the patient retained the sinus rhythm. A review of the literature on cardiac autotransplantation revealed that this type of surgery has been performed frequently in centers that have a cardiac transplantation program or a surgeon who has cardiac transplantation experience. To our knowledge, this report is the first of cardiac autotransplantation for benign hemangioma.

References

Bakaeen FG, Reardon MJ, Coselli JS, et al. 2003. Surgical outcome in 85 patients with primary cardiac tumors. Am J Surg 186:641-7; discussion 647.\nBarbukhatti KO, Boldyrev SY, Antipov GN, Porhanov VA. 2009. First experience of cardiac autotransplantation for giant left atrium treatment. Interact Cardiovasc Thorac Surg 8:173-5.\nBertrand ME, Lablanche JM, Tilmant PY, Ducloux G, Warembourg H Jr, Soots G. 1981. Complete denervation of the heart (autotransplantation) for treatment of severe, refractory coronary spasm. Am J Cardiol 47:1375-8.\nBlackmon SH, Patel AR, Bruckner BA, et al. 2008. Cardiac autotransplantation for malignant or complex primary left-heart tumors. Tex Heart Inst J 35:296-300.\nBurke A, Johns JP, Virmani R. 1990. Hemangiomas of the heart. A clinicopathologic study of ten cases. Am J Cardiovasc Pathol 3:283-90.\nCatton C. 2008. The management of malignant cardiac tumors: clinical considerations. Semin Diagn Pathol 25:69-75.\nClark DA, Quint RA, Mitchell RL, Angell WW. 1977. Coronary artery spasm: medical management, surgical denervation, and autotransplantation. J Thorac Cardiovasc Surg 73:332-9.\nColucci WS, Schoen FJ. 2001. Primary tumors of the heart. In: Braunwald E, Zipes DP, Libby P, eds. Heart disease: a textbook of cardiovascular medicine. 6th ed. Philadelphia, Pa: W. B. Saunders. p 1807-22.\nDoty DB, Doty JR, Reid BB, Anderson JL. 2006. Left atrial sarcoma: resection and repair by cardiac autotransplant and in situ pericardial patch. Ann Thorac Surg 82:1514-7.\nElbardissi AW, Dearani JA, Daly RC, et al. 2008. Survival after resection of primary cardiac tumors: a 48-year experience. Circulation 118(suppl):S7-15.\nEl-Essawi A, Biancosino C, Anssar M, Kutschka I, Breitenbach I, Harringer W. 2007. Atrioventricular disruption managed by ex-situ repair and autotransplantation. J Heart Valve Dis 16:359-61.\nGammie JS, Abrishamchian AR, Griffith BP. 2007. Cardiac autotransplantation and radical bi-atrial resection for recurrent atrial myxoma. Ann Thorac Surg 83:1545-7.\nGordeev ML, Naimushin AV, Khudonogova SV, et al. 2006. Autotransplantation of the heart as a method of treatment of valvular disease, atriomegalia with pronounced disturbances of hemodynamics [in Russian]. Vestn Khir Im I I Grek 165:78-82.\nGowdamarajan A, Michler RE. 2000. Therapy for primary cardiac tumors: Is there a role for heart transplantation? Curr Opin Cardiol 15:121-5.\nIskander SS, Nagueh SF, Ostrowski ML, Reardon MJ. 2005. Growth of a left atrial sarcoma followed by resection and autotransplantation. Ann Thorac Surg 79:1771-4.\nKawada M, Oda K, Hirose K, Fukutomi T, Yamashiro T, Ogoshi S. 1996. A case report of surgical treatment for left ventricular papillary fibroelastoma [in Japanese]. Nippon Kyobu Geka Gakkai Zasshi 44:1159-62.\nKudo M, Misumi T, Koizumi K, Suzuki T, Nakagawa M. 2004. Intraoperative trans-mitral endoscopic resection of left ventricular tumor. Jpn J Thorac Cardiovasc Surg 52:308-10.\nKurian KC, Edwards FH, Jacob B, Monteiro C, Chiong J. 2006. Papillary fibroelastoma presenting as left ventricular mass. Tex Heart Inst J 33:63-5.\nLam KY, Dickens P, Chan AC. 1993. Tumors of the heart: a 20-year experience with a review of 12,485 consecutive autopsies. Arch Pathol Lab Med 117:1027-31.\nLivi U, Rizzoli G. 1998. Autotransplantation procedure for giant left atrium repair. Heart Surg Forum 1:71-5.\nMichler RE, Goldstein DJ. 1997. Treatment of cardiac tumors by orthotopic cardiac transplantation. Semin Oncol 24:534-9.\nNovitzky D, Perry R, Ndaba D, Bowen T. 2003. Cardiac autotransplantation for mitral valve replacement. Heart Surg Forum 6:424-8.\nOdim J, Reehal V, Laks H, Mehta U, Fishbein MC. 2003. Surgical pathology of cardiac tumors. Two decades at an urban institution. Cardiovasc Pathol 12:267-70.\nOkita Y, Miki S, Ueda Y, Tahata T, Sakai T, Matsuyama K. 1994. Recurrent malignant fibrous histiocytoma of the left atrium with extracardiac extension. Am Heart J 127:1624-8.\nPfeiffer D, Fiehring H, Warnke H, Pech HJ, Jenssen S. 1992. Treatment of tachyarrhythmias in a patient with the long QT syndrome by autotransplantation of the heart and sinus node-triggered atrial pacing. J Thorac Cardiovasc Surg 104:491-4.\nRammos KS, Ketikoglou DG, Hatzibougias IG. 2007. Large left ventricular capillary hemangioma with cavernous areas. Tex Heart Inst J 34:128-9.\nReardon MJ, DeFelice CA, Sheinbaum R, Baldwin JC. 1999. Cardiac autotransplant for surgical treatment of a malignant neoplasm. Ann Thorac Surg 67:1793-5.\nReardon MJ, Malaisrie SC, Walkes JC, et al. 2006. Cardiac autotransplantation for primary cardiac tumors. Ann Thorac Surg 82:645-50.\nReardon MJ, Walkes JC, DeFelice CA, Wojciechowski Z. 2006. Cardiac autotransplantation for surgical resection of a primary malignant left ventricular tumor. Tex Heart Inst J 33:495-7.\nReynen K. Frequency of primary tumors of the heart. 1996. Am J Cardiol 77:107.\nRosetti M, Tighe DA, Chandok D, Gammie JS, Griffith BP, Folland ED. 2006. An unusual cause of pulmonary vein stenosis: a case report and review of the literature. Echocardiography 23:685-8.\nScheld HH, Nestle HW, Kling D, Stertmann WA, Langebartels H, Hehrlein FW. 1988. Resection of a heart tumor using autotransplantation. Thorac Cardiovasc Surg 36:40-3.\nTroise G, Brunelli F, Cirillo M, et al. 2003. Cardiac autotransplantation for the treatment of permanent atrial fibrillation combined with mitral valve disease. Heart Surg Forum 6:138-42.\nVander Salm TJ. 2000. Unusual primary tumors of the heart. Semin Thorac Cardiovasc Surg 12:89-100.\nWagner S, Hutchisson B, Baird MG. 1999. Cardiac explantation and autotransplantation. AORN J 70:99-100, 102, 104-7; quiz 108-12.\nWang CH, Yu HY, Chi NS, et al. 2006. Complete excision of primary cardiac malignant fibrous histiocytoma involving the left atrial free wall and mitral annulus by modified autotransplantation. J Thorac Cardiovasc Surg 131:731-3.\n
Published
2009-10-15
How to Cite
Novitzky, D., Guglin, M., & Sheffield, C. (2009). Cardiac Autotransplantation for Removal of Left Atrial Hemangioma and a Review of the Literature. The Heart Surgery Forum, 12(5), E279-E284. https://doi.org/10.1532/HSF98.20091027
Section
Articles

Most read articles by the same author(s)