Radical Resection of Cardiac Sarcoma

Abstract

We report on our experience with six patients with malignant sarcoma of the heart and show that long-term survival is possible after radical resection. At presentation, the 6 patients (3 male, 3 female) were 45.8 ± 20 years old. Three patients are alive without evidence of metastases since 29.6 ± 36.8 months, three patients died after 38 ± 50.2 months due to distant metastases.

Precise preoperative localization of the tumor by means of imaging techniques is very important. In some cases, radical surgery requires an ex situ procedure (autotransplantation). If necessary, the right heart can be resected almost completely, and reconstructed in the form of a Fontan-type circulation. A heart transplantation, as suggested by others, is not justified from our point of view, since prognosis is not better and donor organs are too rare. The results of radical resection are promising, but new concepts for treatment - in particular chemotherapy concepts - for these mostly middle-aged or young patients are required.

Key words

Primary heart tumors - radical resection - chemotherapy

References

• 1 Chomette G, Auriol M, Cabrol C, Tranbaloc P. [Primary malignant tumors of the heart. Anatomo-clinical study of 12 cases].  Ann Med Interne (Paris). 1985;  136 301-305
• 2 Blondeau P. Primary cardiac tumors - French studies of 533 cases.  Thorac Cardiovasc Surg. 1990;  38 (Suppl 2) 192-195
• 3 Dein J R, Frist W H, Stinson E B, Miller D C, Baldwin J C, Oyer P E. et al . Primary cardiac neoplasms. Early and late results of surgical treatment in 42 patients.  J Thorac Cardiovasc Surg. 1987;  93 502-511
• 4 Murphy M C, Sweeney M S, Putnam Jr J B, Walker W E, Frazier O H, Ott D A. et al . Surgical treatment of cardiac tumors: a 25-year experience.  Ann Thorac Surg. 1990;  49 612-617 discussion 617-618
• 5 Reece I J, Cooley D A, Frazier O H, Hallman G L, Powers P L, Montero C G. Cardiac tumors. Clinical spectrum and prognosis of lesions other than classical benign myxoma in 20 patients.  J Thorac Cardiovasc Surg. 1984;  88 439-446
• 6 Shechter M, Glikson M, Agranat O, Motro M. Echocardiographic demonstration of mitral block caused by left atrial spindle cell sarcoma.  Am Heart J. 1992;  123 232-234
• 7 Kamiya H, Yasuda T, Nagamine H, Sakakibara N, Nishida S, Kawasuji M. et al . Surgical treatment of primary cardiac tumors: 28 years' experience in Kanazawa University Hospital.  Jpn Circ J. 2001;  65 315-319
• 8 Vander Salm T J. Unusual primary tumors of the heart.  Semin Thorac Cardiovasc Surg. 2000;  12 89-100
• 9 Piper S N, Werner U, Maleck W H, Schmidt C C, Saggau W, Munderloh K H. et al . Recurrent atrial sarcoma presenting as an atrial myxoma. Long-term survival due to surgical intervention and chemotherapy.  J Cardiovasc Surg (Torino). 2000;  41 961-964
• 10 Engberding R, Daniel W G, Erbel R, Kasper W, Lestuzzi C, Curtius J M. et al . Diagnosis of heart tumours by transoesophageal echocardiography: a multicentre study in 154 patients. European Cooperative Study Group.  Eur Heart J. 1993;  14 1223-1228
• 11 Burke A P, Cowan and Virmani D R. Primary sarcomas of the heart.  Cancer. 1992;  69 387-395
• 12 Awad M, Dunn B, al Halees Z, Mercer E, Akhtar M, Hainau B. et al . Intracardiac rhabdomyosarcoma: transesophageal echocardiographic findings and diagnosis.  J Am Soc Echocardiogr. 1992;  5 199-202
• 13 Bear P A, Moodie D S. Malignant primary cardiac tumors. The Cleveland Clinic experience, 1956 to 1986.  Chest. 1987;  92 860-862
• 14 Wagner S, Hutchisson B, Baird M G. Cardiac explantation and autotransplantation.  Aorn J. 1999;  70 99-112
• 15 Scheld H H, Nestle H W, Kling D, Stertmann W A, Langebartels H, Hehrlein F W. Resection of a heart tumor using autotransplantation.  Thorac Cardiovasc Surg. 1988;  36 40-43
• 16 Aravot D J, Banner N R, Madden B, Aranki S, Khaghani A, Fitzgerald M. et al . Primary cardiac tumours - is there a place for cardiac transplantation?.  Eur J Cardiothorac Surg. 1989;  3 521-524
• 17 Siebenmann R, Jenni R, Makek M, Oelz O, Turina M. Primary synovial sarcoma of the heart treated by heart transplantation.  J Thorac Cardiovasc Surg. 1990;  99 567-568
• 18 Überfuhr P, Meiser B, Fuchs A, Schulze C, Reichenspurner H, Falk M. et al . Heart transplantation: an approach to treating primary cardiac sarcoma?.  J Heart Lung Transplant. 2002;  21 1135-1139
• 19 Babatasi G, Massetti M, Agostini D, Galateau F, Saloux E, Nataf P. et al . Recurrent left-sided heart leiomyosarcoma: should heart transplantation be legitimate?.  J Heart Lung Transplant. 1998;  17 1133-1138