Surgical Treatment of Liposarcoma Metastasis of the Heart

The patient featured in this video is a fifty-two-year-old woman with a previous history of liposarcoma of the thigh. She underwent surgery in 2003 and was on follow-up until 2013 with no evidence of disease recurrence. In January 2021, she was admitted to the hospital for increasing dyspnea and asthenia. A transthoracic echocardiography showed pericardial effusion and cardiac tamponade, so a pericardiocentesis was performed with 1.100 cc drainage and no malignant cells in the chemical analysis. The next day, a novel echocardiography showed a homogeneous solid mass in the pericardium. The magnetic resonance imaging (MRI) confirmed the presence of a solid tumor (6x5cm), with epicardial implant site on the right ventricle. Then a contrast-enhanced CT scan was used for presurgical planning, providing additional anatomic information of the tumor and relationships with the next structures. A 3D rendering was helpful while planning the different phases of intervention.

In March 2021, the patient underwent cardiac surgery. After a median sternotomy and pericardium opening, the tumor was identified. The surgeon performed multiple cuts all around until the mass was removed from the right ventricle, and a ventriculotomy was performed to remove pathological tissue fused to the myocardial tissue. After cardiopulmonary bypass was established, the edges of the lesion on the right ventricle were treated with cryoenergy. Then, the anterior wall of the right ventricle was accurately excised and repaired with a bovine pericardial patch. The patient was admitted to the intensive care with minimum inotropic support and discharged ten days after the surgery. A CT scan and echocardiography were performed at the discharge, and after six months the patient had no evidence of recurrence and good right ventricular function.

References

Cardiac metastases from primary myxoid liposarcoma of the thigh: a case report; K. Ikuta, World J Surg Oncol. 2020; 18: 227; doi: 10.1186/s12957-020-02009-0

Liposarcoma causing left ventricular outflow tract obstruction and syncope: a case report and review of the literature; Enrique B Fairman; Int J Cardiovasc Imaging . 2005; doi: 10.1007/s10554-005-0653-0

Liposarcoma. A study of 103 cases. Enzinger FH, Winslow DJ. Virchows Arch Pathol Anat 1962; 355: 367-388