Document Detail


Cardiac autotransplantation for removal of left atrial hemangioma and a review of the literature.
MedLine Citation:
PMID:  19833595     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 x 4 x 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.
Authors:
Dimitri Novitzky; Maya Guglin; Cedric Sheffield
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  The heart surgery forum     Volume:  12     ISSN:  1522-6662     ISO Abbreviation:  Heart Surg Forum     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-16     Completed Date:  2010-01-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100891112     Medline TA:  Heart Surg Forum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E279-84     Citation Subset:  IM    
Affiliation:
University of South Florida, Tampa, Florida 33606 , USA. dnovitzk@health.usf.edu
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MeSH Terms
Descriptor/Qualifier:
Cardiopulmonary Bypass
Echocardiography, Transesophageal
Heart Atria / surgery*,  ultrasonography
Heart Failure / surgery*,  ultrasonography
Heart Neoplasms / surgery*,  ultrasonography
Hemangioma, Cavernous / surgery*,  ultrasonography
Humans
Male
Middle Aged
Replantation / methods*
Transplantation, Autologous

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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