Abstract
We report here on a 43-year-old female patient presenting with non-ST elevation myocardial infarction, severe mitral regurgitation, and mild mitral stenosis secondary to encroachment of the related structures by a primary cardiac angiosarcoma. A coronary angiography revealed significant stenosis in the left main and left circumflex arteries and at exploration, the tumour was arising from posterior left atrial free wall, invading the posterior mitral leaflet, and extending into all of the pulmonary veins and pericardium. Therefore, no further intervention was performed, except for left internal mammarian artery to left anterior descending artery anastomosis and biopsy. As far as we know, this case is unique with respect to its presentation.
Highlights
Primary cardiac tumours are rare clinical entities with a frequency of 0.0017 to 0.03% based on autopsies
Angiosarcomas usually originate in the right atrium and are associated with a poor prognosis because of their aggressive nature and delay in the diagnosis due to insidious onset [2]
Figure 1: ((a) and (b)) Transesophageal echocardiogram midesophageal 4-chamber view at 0∘. (a) Color Doppler image shows severe (III/IV) mitral regurgitation. (b) The two-dimensional image shows an echogenic mass in the left atrium, arising from the region of the posterior mitral leaflet and causing restriction of the movements of this leaflet. (c) Coronary angiogram showing significant stenoses at the left main (70%) and circumflex (80%) arteries. (d) Intraoperative view of the pericardial space
Summary
Primary cardiac tumours are rare clinical entities with a frequency of 0.0017 to 0.03% based on autopsies. Most of the primary cardiac tumours are benign, but approximately 25% are malignant, and the majority of these are sarcomas [1]. Angiosarcomas usually originate in the right atrium and are associated with a poor prognosis because of their aggressive nature and delay in the diagnosis due to insidious onset [2]. We report on a case of primary angiosarcoma of the left atrium. To the best of our knowledge, this case is unique in that the patient presented with mitral insufficiency and AMI (Acute Myocardial Infarction) due to encroachment of the related structures by the tumour
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