J Korean Med Sci.  2017 Sep;32(9):1548-1551. 10.3346/jkms.2017.32.9.1548.

Autotransplantation of the Heart for Recurrent Inflammatory Myofibroblastic Tumor

• Park HO
• Yang JH
• Kim SH
• Moon SH
• Byun JH
• Choi JY
• Lee CE
• Yang JW
• Kim JW

• KMID: 2385964
• DOI: http://doi.org/10.3346/jkms.2017.32.9.1548

Abstract

We report a rare case of dyspnea caused by a cardiac tumor in a 53-year-old woman. The patient had undergone a cardiac tumor (inflammatory myofibroblastic tumor, 6.2 × 4.2 × 3.3 cm) resection at our institute 13 months earlier. We performed preoperative evaluations which revealed a cardiac tumor originating from the posterior wall of the left atrium. Cardiac autotransplantation surgery (cardiac explantation, ex vivo tumor resection, cardiac reconstruction, and cardiac reimplantation) was successfully performed for the complete resection of the recurrent tumor without major postoperative complications. The patient showed good physical conditions for 21 months after the surgery. Cardiac autotransplantation is a safe and feasible technique for the complete resection of complex left atrial tumors.

Keyword

Heart; Transplantation; Autologus; Myofibroblastic Tumor

MeSH Terms

Autografts*
Dyspnea
Female
Heart Atria
Heart Neoplasms
Heart*
Humans
Middle Aged
Myofibroblasts*
Postoperative Complications
Transplantation
Transplantation, Autologous*

Figure

• 

  Fig. 1 Preoperative and postoperative images of CT and TTE. (A) Preoperative CT scan showing the stalk of the tumor arising from the posterior wall of the LA (arrow). (B) Preoperative echocardiography showing a huge mobile mass in the LA obstructing mitral valve inflow (arrow). (C, D). Postoperative CT and TTE showed no remnant mass. CT = computed tomography, TTE = transthoracic echocardiography, LA = left atrium.

• 

  Fig. 2 Intraoperative findings. (A) Explanted heart was preserved in a solution composed of iced saline and HTK solution. The tumor was on the posterior portion of the left atrial wall and invaded the LA appendage (arrow). (B) After explantation of the heart. Pulmonary veins were invaded by the tumor (arrow). (C) The posterior wall of the LA was reconstructed using bovine pericardium. (D) Ex vivo reconstruction of the left atrial wall using autologous pericardium (arrow). HTK = histidine-tryptophan-ketoglutarate, LA = left atrium.

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  Fig. 3 Macroscopic and microscopic findings of inflammatory fibroblastic tumor. (A) Macroscopic view of the inflammatory fibroblastic tumor after resection. (B) Immunohistochemistry for smooth muscle actin. The tumor cells showing cytoplasmic staining for smooth muscle actin in the focal area (arrows) (× 200). HTK = histidine-tryptophan-ketoglutarate.

Reference

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