PRIMARY CARDIAC ANGIOSARCOMA INVADING BIOPROSTHETIC MITRAL VALVE

Abstract

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Primary cardiac tumors have an occurrence rate of 0.0001% - 0.03% on large autopsy series. The angiosarcoma variety are locally aggressive, however there are no previous reports of invasion of a bioprosthetic mitral valve. This may be partially due to the predisposition of malignant cardiac tumors to be right sided. CASE PRESENTATION: We present a 52-year-old female with a past medical history of rheumatic heart disease that came to the hospital for worsening shortness of breath and chest pain. She had undergone a surgical mitral valve replacement 5 years prior. To evaluate for possible endocarditis a trans-esophageal echocardiogram was performed which showed a large mass overlying the mitral annulus and significant bioprosthetic stenosis. This mass protruded across the mitral valve and extended into the left atrial appendage. During removal of the compromised bioprosthetic mitral valve a significant amount of foreign material was noted in and around the valve and a large tumor-like mass involving part of the interatrial septum was resected. A 27 mm Perimount Magna Mitral Ease valve was seated in the supra-annular position. The interatrial septum was reconstructed using a 2 cm bovine pericardium patch. Initial pathology of the mass revealed foci of high-grade malignant neoplasm, organizing thrombi and mesenchymal tissue. Final pathology was consistent with a high-grade epithelioid angiosarcoma. This patient is currently undergoing chemotherapy and radiation therapy. DISCUSSION: Overall survival of patients with primary cardiac angiosarcoma is approximately 1 year. Patients that undergo surgical resection of the tumor have a greater survival than those treated with chemotherapy and radiation alone. Surgical resection is technically difficult due to proximity to important vascular structures. Improvement in overall survival rates has been difficult due to the rarity of the condition. CONCLUSIONS: Primary cardiac angiosarcoma is a rare condition with very poor outcomes. Surgical resection is the cornerstone of treatment, however survival is poor regardless. Reference #1: Lam KY, Dickens P, Chan AC. Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies. Arch Pathol Lab Med. 1993;117(10):1027-31. Reference #2: Patel SD, Peterson A, Bartczak A, et al. Primary cardiac angiosarcoma - a review. Med Sci Monit. 2014;20:103-9. Published 2014 Jan 23. https://doi.org/10.12659/MSM.889875 Reference #3: Look hong NJ, Pandalai PK, Hornick JL, et al. Cardiac angiosarcoma management and outcomes: 20-year single-institution experience. Ann Surg Oncol. 2012;19(8):2707-15. DISCLOSURES: No relevant relationships by Raul Alonso, source=Web Response No relevant relationships by Daryoosh Derakhshan, source=Web Response No relevant relationships by Christopher Foth, source=Web Response No relevant relationships by Marc Iskandar, source=Web Response No relevant relationships by Vy Nguyen, source=Web Response No relevant relationships by Josue Rizo, source=Web Response