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Primary Left Cardiac Angiosarcoma with Mitral Valve Involvement Accompanying Coronary Artery Disease.

Baran C, Durdu S, Eryilmaz S, Sirlak M, Akar AR - Case Rep Surg (2015)

Bottom Line: We report here on a 43-year-old female patient presenting with non-ST elevation myocardial infarction, severe mitral regurgitation, and mild mitral stenosis secondary to encroachment of the related structures by a primary cardiac angiosarcoma.Therefore, no further intervention was performed, except for left internal mammarian artery to left anterior descending artery anastomosis and biopsy.As far as we know, this case is unique with respect to its presentation.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Surgery, Ankara University School of Medicine, Cebeci Heart Center, Dikimevi, 06340 Ankara, Turkey.

ABSTRACT
We report here on a 43-year-old female patient presenting with non-ST elevation myocardial infarction, severe mitral regurgitation, and mild mitral stenosis secondary to encroachment of the related structures by a primary cardiac angiosarcoma. A coronary angiography revealed significant stenosis in the left main and left circumflex arteries and at exploration, the tumour was arising from posterior left atrial free wall, invading the posterior mitral leaflet, and extending into all of the pulmonary veins and pericardium. Therefore, no further intervention was performed, except for left internal mammarian artery to left anterior descending artery anastomosis and biopsy. As far as we know, this case is unique with respect to its presentation.

No MeSH data available.


Related in: MedlinePlus

((a) and (b)) Transesophageal echocardiogram midesophageal 4-chamber view at 0°. (a) Color Doppler image shows severe (III/IV) mitral regurgitation. (b) The two-dimensional image shows an echogenic mass in the left atrium, arising from the region of the posterior mitral leaflet and causing restriction of the movements of this leaflet. (c) Coronary angiogram (left anterior oblique view with caudal angulation) showing significant stenoses at the left main (70%) and circumflex (80%) arteries (arrows). (d) Intraoperative view of the pericardial space. Extensive and multiple masses in the pericardium and multifocal central hemorrhage in the epicardium are shown.
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fig1: ((a) and (b)) Transesophageal echocardiogram midesophageal 4-chamber view at 0°. (a) Color Doppler image shows severe (III/IV) mitral regurgitation. (b) The two-dimensional image shows an echogenic mass in the left atrium, arising from the region of the posterior mitral leaflet and causing restriction of the movements of this leaflet. (c) Coronary angiogram (left anterior oblique view with caudal angulation) showing significant stenoses at the left main (70%) and circumflex (80%) arteries (arrows). (d) Intraoperative view of the pericardial space. Extensive and multiple masses in the pericardium and multifocal central hemorrhage in the epicardium are shown.

Mentions: A 43-year-old woman with no known history of CAD (Coronary Artery Disease) was presented to our hospital's cardiology clinic with a six-hour history of severe central chest pain and dyspnea. She does not have any known traditional CAD risk factors, arrhythmias, and was haemodynamically relatively stable at the time of admission. Cardiac auscultation revealed a grade 2-3/6 systolic murmur that was the loudest at the apex (fifth left intercostal space, midclavicular line). Lungs were clear to auscultation. Electrocardiography demonstrated sinus tachycardia (105/beats/minute) and ST-segment depression of approximately 3 mm in leads V1 to V6. Her cardiac markers were elevated (troponin I: 14.6 ng/L; normal range: 0.0–0.01 ng/L and creatinine kinase-MB mass: 53.9 ng/mL; normal range: 0.0–3.6 ng/mL). So a diagnosis of acute non-ST elevation myocardial infarction was made, and the patient was started on aspirin, intravenous heparin, intravenous nitroglycerin, and intravenous metoprolol. After TT (Transthoracic) and TE (Transesophageal) echocardiography, she was also diagnosed as having an echogenic mass in the left atrium arising from the region of the posterior mitral leaflet and causing restriction of the movement of this leaflet and, consequently, a grade III/IV mitral regurgitation and a mild degree of mitral stenosis (mean mitral valve area: 2.7 cm2 and mean transmitral diastolic gradient: 6 mmHg) (Figures 1(a) and 1(b)). The patient was then taken to the cardiac catheterization laboratory. Coronary angiogram revealed significant stenosis in the main coronary and left circumflex arteries (70% and 80% in diameter, resp.) and a normal right coronary artery (Figure 1(c)). Then, an informed consent was obtained and the patient underwent emergency open heart surgery. A surgical exploration revealed extensive and multiple solid masses in the pericardium and multifocal central hemorrhage on the epicardium (Figure 1(d)). These findings were to make it extremely difficult to isolate the coronary arteries, and therefore only a left interior mammarian artery to left anterior descending artery anastomosis was performed.


Primary Left Cardiac Angiosarcoma with Mitral Valve Involvement Accompanying Coronary Artery Disease.

Baran C, Durdu S, Eryilmaz S, Sirlak M, Akar AR - Case Rep Surg (2015)

((a) and (b)) Transesophageal echocardiogram midesophageal 4-chamber view at 0°. (a) Color Doppler image shows severe (III/IV) mitral regurgitation. (b) The two-dimensional image shows an echogenic mass in the left atrium, arising from the region of the posterior mitral leaflet and causing restriction of the movements of this leaflet. (c) Coronary angiogram (left anterior oblique view with caudal angulation) showing significant stenoses at the left main (70%) and circumflex (80%) arteries (arrows). (d) Intraoperative view of the pericardial space. Extensive and multiple masses in the pericardium and multifocal central hemorrhage in the epicardium are shown.
© Copyright Policy - open-access
Related In: Results  -  Collection

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fig1: ((a) and (b)) Transesophageal echocardiogram midesophageal 4-chamber view at 0°. (a) Color Doppler image shows severe (III/IV) mitral regurgitation. (b) The two-dimensional image shows an echogenic mass in the left atrium, arising from the region of the posterior mitral leaflet and causing restriction of the movements of this leaflet. (c) Coronary angiogram (left anterior oblique view with caudal angulation) showing significant stenoses at the left main (70%) and circumflex (80%) arteries (arrows). (d) Intraoperative view of the pericardial space. Extensive and multiple masses in the pericardium and multifocal central hemorrhage in the epicardium are shown.
Mentions: A 43-year-old woman with no known history of CAD (Coronary Artery Disease) was presented to our hospital's cardiology clinic with a six-hour history of severe central chest pain and dyspnea. She does not have any known traditional CAD risk factors, arrhythmias, and was haemodynamically relatively stable at the time of admission. Cardiac auscultation revealed a grade 2-3/6 systolic murmur that was the loudest at the apex (fifth left intercostal space, midclavicular line). Lungs were clear to auscultation. Electrocardiography demonstrated sinus tachycardia (105/beats/minute) and ST-segment depression of approximately 3 mm in leads V1 to V6. Her cardiac markers were elevated (troponin I: 14.6 ng/L; normal range: 0.0–0.01 ng/L and creatinine kinase-MB mass: 53.9 ng/mL; normal range: 0.0–3.6 ng/mL). So a diagnosis of acute non-ST elevation myocardial infarction was made, and the patient was started on aspirin, intravenous heparin, intravenous nitroglycerin, and intravenous metoprolol. After TT (Transthoracic) and TE (Transesophageal) echocardiography, she was also diagnosed as having an echogenic mass in the left atrium arising from the region of the posterior mitral leaflet and causing restriction of the movement of this leaflet and, consequently, a grade III/IV mitral regurgitation and a mild degree of mitral stenosis (mean mitral valve area: 2.7 cm2 and mean transmitral diastolic gradient: 6 mmHg) (Figures 1(a) and 1(b)). The patient was then taken to the cardiac catheterization laboratory. Coronary angiogram revealed significant stenosis in the main coronary and left circumflex arteries (70% and 80% in diameter, resp.) and a normal right coronary artery (Figure 1(c)). Then, an informed consent was obtained and the patient underwent emergency open heart surgery. A surgical exploration revealed extensive and multiple solid masses in the pericardium and multifocal central hemorrhage on the epicardium (Figure 1(d)). These findings were to make it extremely difficult to isolate the coronary arteries, and therefore only a left interior mammarian artery to left anterior descending artery anastomosis was performed.

Bottom Line: We report here on a 43-year-old female patient presenting with non-ST elevation myocardial infarction, severe mitral regurgitation, and mild mitral stenosis secondary to encroachment of the related structures by a primary cardiac angiosarcoma.Therefore, no further intervention was performed, except for left internal mammarian artery to left anterior descending artery anastomosis and biopsy.As far as we know, this case is unique with respect to its presentation.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Surgery, Ankara University School of Medicine, Cebeci Heart Center, Dikimevi, 06340 Ankara, Turkey.

ABSTRACT
We report here on a 43-year-old female patient presenting with non-ST elevation myocardial infarction, severe mitral regurgitation, and mild mitral stenosis secondary to encroachment of the related structures by a primary cardiac angiosarcoma. A coronary angiography revealed significant stenosis in the left main and left circumflex arteries and at exploration, the tumour was arising from posterior left atrial free wall, invading the posterior mitral leaflet, and extending into all of the pulmonary veins and pericardium. Therefore, no further intervention was performed, except for left internal mammarian artery to left anterior descending artery anastomosis and biopsy. As far as we know, this case is unique with respect to its presentation.

No MeSH data available.


Related in: MedlinePlus