P172 Uncommon reason for right-sided heart failure

Abstract

Abstract This paper outlines a case study 57 year old, female patient who was admitted in our institution due to severe sign and symptoms of right-sided heart failure. She complained on progressive fatigue, a shortness of breath and oedema of cruris for three months before. Initially she was hospitalized in regional hospital due to pericardial effusion and they excluded any malignancy and systemic tissue disease in that moment. Immediately after admission we have performed 2D transthoracic echocardiography which showed a large (6.7x4.9cm), oval tumours soft tissue formation in right atrium which compromise flow in Vena cava inferior and across tricuspid valve and make a gradient of 35 mmHg above it. Left and right ventricles had preserved dimensions and function, without pericardial effusion. 3D transoesophageal echocardiography (TEE) imaged confirmed huge, oval tumorous formation (8.2x7.9cm), which originated from lateral wall of right atrium and almost occupied it, compromising flow towards superior and inferior vena cava. We had detected an irregular free space, probably due to necrosis, in the middle part of that tumorous formation. Thorax MSCT revealed heterogeneous expansive mass (19x8x8 cm) in projection of right atrium with signs of active bleeding its central part, although MSCT couldn’t exclude extra cardiac origin. There were no signs of dissemination. Cardiac MR indicated that we had extra cardiac mass (12x9x10cm) close to lateral right atrial wall and basal part of lateral wall of right ventricle which compromise flow towards superior and inferior vena cava, with no changes on surrounding structures. The patient underwent almost complete tumour surgical resection, with a lot of bleeding complications due to its local invasiveness and central necrosis. Surgical findings completely were concordant with 3D TEE imagining which provided us very precise information about size, location and extension of tumour. Severe systemic inflammatory response syndrome (SIRS) occurred in the postoperative period, and the patient died due to multiple organ dysfunction. Patohistological analyses were conclusive of undifferentiated pleomorphic sarcoma diagnosis. Abstract P172 Figure.