Surgical Resection of Atypical Metastatic Melanoma to the Atriocaval Junction

Abstract

Background: Metastatic tumors to the heart include lymphomas, sarcoma, leukemia, and melanoma. Of these, metastatic melanoma is the most common, and are usually hematogenous, where metastatic lesions can be present in the left ventricle, right atrium, and/ or the right ventricle. Objective: We present an atypical metastatic melanoma pattern, where cardiac metastasis originated by direct extension from the adjacent gastric mesentery. We also present our trans-cardiac resection approach, which was the safest way to access the cardiac metastasis intra-operatively without disrupting the tumor. Method: This was an incidental intraoperative finding, and no formal study methods were employed. During the operation, the atrium was opened via standard procedures. The point of tumor adherence to the posterior atrial wall was identified and resected. The tumor was found to extend by a pedicle into the mesentery of the gastric pull-up. Result: The outcome of this procedure was favorable. The tumor was completely resected, along with the adjacent heart and mesenteric tissues. The edges of the atrial tissues were cryoablated to eliminate any micro-invasion, and at 2-week follow-up, patient indicated significant improvement in pre-operative symptoms. Conclusion: Our patient’s metastatic melanoma presented as a solitary metastasis to the right atrial caval junction. Trans-cardiac resection of the tumor was affected with deep hypothermic circulatory arrest without complications. We recommend this as the safest way to access the tumor at the atrial caval junction.