Right Atrial and Bicaval Reconstruction for Cardiac Sarcoma.

Sarcomas represent the most common primary cardiac malignancy. A poor prognosis can be improved with multimodal management including aggressive surgical reconstruction in combination with neoadjuvant or adjuvant therapy. We present the case of a primary cardiac sarcoma to describe our approach to a more radical right atrial and bicaval reconstruction.

When Is Resection of a Cardiac Tumor With Metastatic Disease Acceptable?

Metastatic disease is a relative contraindication for resection of malignant cardiac tumors. However, certain situations may present themselves when primary cardiac resection may be warranted. We present a 21-year-old male diagnosed with metastatic epithelioid hemangioendothelioma with right ventricular outflow tract involvement for whom surgical resection was successfully performed and discuss strategies.

High-Risk Features and Utility of Computed Tomography-Fluoroscopy-Guided Biopsy as a Diagnostic Tool.

Left atrial masses are most commonly diagnosed as myxomas. When clinicians doubt the diagnosis, a biopsy is warranted. However, this can be very difficult with left-sided tumors.

Primary Cardiac Diffuse Large B-Cell Lymphoma: Diagnostic Journey of Undifferentiated Right Atrial Mass.

Undifferentiated cardiac tumors represent a diagnostic dilemma that requires meticulous workup. We present the case of a 67-year-old woman with a right atrial mass that was investigated with multiple modalities before being diagnosed as a cardiac lymphoma. The role of transvenous and/or percutaneous biopsy for guiding diagnosis and management is emphasized.

Surgical and multimodal approaches to right-sided cardiac tumours.

Purpose Of Review: Cardiac tumours present significant clinical challenges due to their wide differential, complex anatomical and physiological implications, as well as the potential for widespread invasion in the case of malignancies. This review synthesizes recent findings surrounding the diagnosis and management of specifically right-sided cardiac tumours, with a particular focus on surgical resection and reconstructive techniques.

Recent Findings: Management of cardiac tumours can be categorized into three key phases.

Choice of anesthesia technique is associated with earlier hospital discharge and reduced costs after transcatheter transfemoral aortic valve implantation.

Background: Transcatheter aortic valve implantation (TAVI) has become a viable alternative to palliation in patients with severe aortic stenosis. We compared general anesthesia to conscious sedation for TAVI procedures with respect to post operative morbidity, hospital length of stay, and financial burden.

Methods: We conducted a retrospective review of prospectively collected data in patients undergoing transfemoral TAVI procedures from 2012 to 2017.

Vasculitic rash and cerebral emboli in an adolescent with left atrial myxoma.

A previously healthy woman in late adolescence presented to the emergency department with stroke-like symptoms following a two-month history of bilateral foot pain and oedema, accompanied by a macular rash and progressive lower extremity weakness. On further investigation, she was found to have multiple cerebral emboli and a left atrial myxoma fixed to the interatrial septum. The patient subsequently underwent urgent surgical excision of the myxoma.

Outcomes of expanded polytetrafluoroethylene pericardial membrane implantation in left ventricular assist device explantation and heart transplantation.

Objectives: Redo sternotomy and explantation of left ventricular assist devices (LVAD) for heart transplantation (HT) involve prolonged dissection, potential injury to mediastinal structures and/or bleeding. Our study compared a complete expanded polytetrafluoroethylene (ePTFE) wrap versus minimal or no ePTFE during LVAD implantation, on outcomes of subsequent HT.

Methods: Between July 2005 and July 2018, 84 patients underwent a LVAD implant and later underwent HT.

Modified autotransplantation technique for surgical resection of complex pericardial synovial sarcoma.

Technical details for complex cardiac tumor resection are sparse. We describe the operative technique of modified autotransplantation for resection of a complex pericardial synovial sarcoma in a 63-year-old, Caucasian female. Surgical exposure demonstrated tumor origin at the superior cavoatrial junction and invasion of the aorta, main pulmonary artery, superior pulmonary veins, and left atrial roof.

Association Between Sarcopenia and Adverse Events Following Transcatheter Aortic Valve Implantation.

Background: Sarcopenia, the age-related loss of skeletal muscle mass/function, has been identified as a marker of frailty. We examined the association between sarcopenia and adverse events following transcatheter aortic valve implantation (TAVI).

Methods: A retrospective cohort study was conducted at Toronto General Hospital.

Right Ventricular Mass 12 Years after Osteosarcoma: Multimodality Imaging with Pathologic Correlation.

The authors report a 27-year-old woman with a remote left femoral osteosarcoma and amputation above the left knee who presented with a large right ventricular mass. Initial evaluation with thoracic CT was inconclusive regarding thrombus versus tumor, but metastatic osteosarcoma was suggested by findings at transthoracic echocardiography, cardiac CT, and cardiac MRI. The patient underwent tumor debulking, and osteosarcoma was confirmed with pathologic examination.

Superior Vena Cava Resection and Reconstruction with Resection of Primary Lung Cancer and Mediastinal Tumor.

The superior vena cava is a short ∼7-cm valveless vessel that brings blood from the upper half of the body to the heart but has connections to the infracardiac venous structures as well. It can become obstructed, mostly by advanced lung cancer but benign conditions account for one-fourth of cases. When possible, reconstruction can be by biological material or via ring reinforced grafts.

Predictors of perforation during lead extraction: Results of the Canadian Lead ExtrAction Risk (CLEAR) study.

Background: Transvenous lead extraction can have serious adverse events, such as cardiac or vascular perforation. Risk factors have not been well characterized.

Objective: The purpose of this study was to identify factors associated with perforation and death, and to characterize lead extraction in a large contemporary population.

Aging impairs human bone marrow function and cardiac repair following myocardial infarction in a humanized chimeric mouse.

Ventricular remodeling following myocardial infarction (MI) is a major cause of heart failure, a condition prevalent in older individuals. Following MI, immune cells are mobilized to the myocardium from peripheral lymphoid organs and play an active role in orchestrating repair. While the effect of aging on mouse bone marrow (BM) has been studied, less is known about how aging affects human BM cells and their ability to regulate repair processes.

Echocardiographic Features of Cardiac Echinococcal Infection.

• Cardiac masses are a rare but important finding requiring detailed investigation. • Echocardiography is a first-line imaging modality. • CT and MRI together allow precise structural and tissue characterization.

Redo sternotomy versus left ventricular assist device explant as risk factors for early mortality following heart transplantation.

Objectives: There is an increasing proportion of patients with a previous sternotomy (PS) or durable left ventricular assist device (LVAD) undergoing heart transplantation (HT). We hypothesized that patients with LVAD support at the time of HT have a lower risk than patients with PS and may have a comparable risk to patients with a virgin chest (VC).

Methods: This is a single-centre retrospective cohort study of all adults who underwent primary single-organ HT between 2002 and 2017.

Spontaneous contained rupture of the nonaneurysmal ascending aorta: Diagnostic importance of pericardial effusion.

A 58-year-old man with a history of hypertension, dyslipidemia, and an obtuse marginal branch coronary stent developed the sudden onset of chest pain. A contrast computed tomography demonstrated a penetrating ulcer of nondilating ascending aorta and a small pericardial effusion. Coronary angiography showed three-vessel disease.