Recurrent Cardiac Sarcoma Resection With Modified Partial Autotransplantation
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SUBMITTER: Campo Dall’Orto A
PROVIDER: S-EPMC8571791 | biostudies-literature |
REPOSITORIES: biostudies-literature
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| S-EPMC9735421 | biostudies-literature
Project description:ObjectiveTo evaluate the outcomes of surgical resection of malignant primary cardiovascular tumors.MethodsFrom 1983 to 2018, 32 patients underwent surgical resection of malignant primary cardiovascular sarcoma at Cleveland Clinic. Mean age was 48 ± 15 years, and 19 (59%) were women. Outcomes are compared between those with complete resection and those without, and in relation to primary location.ResultsThe most common histologic subtypes were angiosarcoma (n = 8 [25%]) and high-grade undifferentiated sarcoma (n = 7 [22%]). Fourteen (44%) involved the left heart, 9 (28%) the right heart, 8 (25%) the pulmonary arteries, and 1 (3%) the aorta. There was clinical evidence of isolated extracardiac metastases in 8 (25%). Six (19%) patients were deemed unresectable at surgery, undergoing biopsy and palliative debulking followed by referral for definitive chemotherapy and/or radiation. The remaining 26 (81%) patients underwent 31 tumor resections with curative intent. Seven (22%) patients had previously undergone a resection or biopsy at another institution. There were 10 second-time resections, 2 third-time resections, 1 fourth-time resection, and no operative mortalities. Median survival was 3 years, with estimated survival at 6 months and 1, 5, and 10 years of 90%, 73%, 31%, and 17%, respectively. Of the 8 (25%) who were considered disease-free following surgery, 4 experienced recurrences during follow-up.ConclusionsPrimary cardiac sarcoma continues to be a challenging disease with poor prognosis. Aggressive resection with curative intent, frequent surveillance for local and distant recurrence, and systemic and local multimodality treatment optimizes outcomes.
| S-EPMC9390277 | biostudies-literature
Project description: Not available
| S-EPMC8298838 | biostudies-literature
Project description:Background:Surgery is the fundamental method for the treatment of primary cardiac tumours. However, due to the inaccessibility of anatomy and the proximity of important structures, it is very difficult to completely resect tumours of the left atrium or left ventricle without damaging the normal tissues. Cardiac autotransplantation for the resection of cardiac tumours is carried out by taking out the heart from the body, resecting cardiac tumours, and then transplanting the heart back into the body. Case summary:This article presents a successful case of cardiac autotransplantation for the complete resection of primary cardiac tumour in a 2-month-old infant and shares the noteworthy experience. Discussion:Tumours located in the left atrium and left ventricle are difficult to be exposed because of their deep posterior location and proximity to important anatomical structures such as mitral valve and chordae tendineae. How to resect the tumours completely without damaging the normal tissues is a great challenge. This case proves that cardiac autotransplantation is a good solution for tumours that are difficult to be resected completely by orthotopic cardiac transplantation.
| S-EPMC7042140 | biostudies-literature
Project description:The transfibular approach is a common procedure for tibiotalar fusion. However, this technique has several concerns: inadequate stability to resist rotational and shearing forces, a fibula is suboptimal for bone grafting, and an onlay fibular graft that might prevent impacting and cause distraction. We present a modified transfibular technique using partial fibular resection and onlay bone graft, which may address these potential problems. This study aimed to evaluate whether the ankle joint is well fused with neutral alignment and functionally improved at the final follow-up. For this study, 27 consecutive patients (mean age, 68.5 years; range, 58-83) who underwent tibiotalar fusion with a follow-up period of >1 year were retrospectively included. A modified transfibular lateral approach was performed, in which the distal anterior half fibula was resected and fixed as an onlay graft to achieve fusion between the tibia, fibula, talus, and fibular onlay graft simultaneously. Radiographic outcomes were assessed using computed tomography at 4 months after operation and serial follow-up radiographs. Functional outcomes were assessed using the American Orthopedic Foot and Ankle Society hindfoot scale and Foot and Ankle Outcome Score. The mean follow-up period was 17.3 (range, 12-32) months. Four months after operation, complete union was achieved in 13 patients, near-complete union in 8 patients, and partial union in the remaining 6 patients. At the final follow-up, all the patients achieved complete union and maintained neutral ankle alignment. The functional outcome showed a significant increase between the preoperative and postoperative periods. One minor complication occurred, in which medial side ankle pain was relieved after screw removal. This modified technique is safe and effective, and has several merits, including saving the soft tissue of the anterior ankle, saving the course of the peroneal tendons by leaving the posterior half of the fibula, resected fibula serving as a good bone stock, and reducing the likelihood of valgus deformity after fibulectomy.
| S-EPMC7580892 | biostudies-literature
Project description:BackgroundRetrohepatic inferior vena cava (RIVC) resection without reconstruction in ex vivo liver resection and autotransplantation (ERAT) for advanced alveolar echinococcosis (HAE) is unclear.MethodsThis is a retrospective study of consecutive patients referred to our hospital from 2014 to 2018. Depending on the presence of a rich collateral circulation and stable blood volume in ERAT, patients did not rebuild the RIVC. Then, patients were selected some appropriate revascularization techniques for the hepatic and renal veins. Finally, all ERAT procedures were completed, and short- and long-term outcomes were observed.ResultsFive advanced HAE patients underwent ERAT without RIVC reconstruction. One patient died of circulatory failure 1 day after surgery. Another four patients, with a median follow-up duration of 18 months (range, 10-25 months), demonstrated normal liver and kidney function, no thrombosis and no HAE recurrence.ConclusionsThrough the long-term results of ERAT, the pros and cons of not reconstructing the RIVC need to be re-examined. In cases with a rich collateral circulation, the RIVC cannot be reconstructed. However, in cases requiring the resection of multiple organs, RIVC without reconstruction was prudential.
| S-EPMC7092598 | biostudies-literature
Project description:Soft tissue sarcomas (STS) are a heterogeneous group of rare mesenchymal tumors that account for approximately 1% of all adult malignancies. They can arise throughout the body due to their mesenchymal origin, although 60% of all STS occur in the extremities. Locally advanced STS can lead to significant functional morbidity and tend to local recurrences despite surgical resection. About 30% of all STS patients develop distant metastases with a median overall survival of less than 15 months. The treatment of choice in patients with localized disease is still surgical resection with negative margins. However, there has been a paradigm shift in the last few decades. Large retrospective analyses could not establish a strong association between radical resections and improved local control or survival. Previous radical concepts in STS surgery have been gradually replaced by more moderate approaches with function- and limb-sparing resections combined with radiotherapy. Here, the margin status appears to be of prognostic significance. However, several large retrospective analyses have presented inconsistent results, questioning the independent prognostic impact of surgical margins. This article reviews the literature critically, focusing on the changing role of surgical margins in STS surgery.
| S-EPMC6754025 | biostudies-literature
Project description:Coronary artery vasospasm is typically managed through avoidance of triggers and with symptomatic treatments with calcium channel blockers and long-acting nitrates. Here, we report a rare case of medically refractory coronary artery vasospasm associated with genetic predispositions that initially required cardiac autotransplantation followed paradoxically by nicotine for long-term symptomatic control. (Level of Difficulty: Intermediate.).
| S-EPMC8353556 | biostudies-literature
Project description:Researchers have shown that adult zebrafish have the potential to regenerate 20% of the ventricular muscle within two months of apex resection, and neonatal mice have the capacity to regenerate their heart after apex resection up until day 7 after birth. The goal of this study was to determine if large mammals (porcine heart model) have the capability to fully regenerate a resected portion of the left ventricular apex during the neonatal stage, and if so, how long the regenerative potential persists. A total of 36 piglets were divided into the following groups: 0-day control and surgical groups and seven-day control and surgical groups. For the apex removal groups, each piglet was subjected to a partial wall thickness resection (~30% of the ventricular wall thickness). Heart muscle function was assessed via transthoracic echocardiograms; the seven-day surgery group experienced a decrease in ejection fraction and fractional shortening. Upon gross necropsy, for piglets euthanized four weeks post-surgery, all 0-day-old hearts showed no signs of scarring or any indication of the induced injury. Histological analysis confirmed that piglets in the 0-day surgery group exhibited various degrees of regeneration, with half of the piglets showing full regeneration and the other half showing partial regeneration. However, each piglet in the seven-day surgery group demonstrated epicardial fibrosis along with moderate to severe dissecting interstitial fibrosis, which was accompanied by an abundant collagenous extracellular matrix as the result of a scar formation in the resection site. Histology of one 0-day apex resection piglet (briefly lain on and accidentally killed by the mother sow three days post-surgery) revealed dense, proliferative mesenchymal cells bordering the fibrin and hemorrhage zone and differentiating toward immature cardiomyocytes. We further examined the heart explants at 5-days post-surgery (5D PO) and 1-week post-surgery (1W PO) to assess the repair progression. For the 0-day surgery piglets euthanized at 5D PO and 1W PO, half had abundant proliferating mesenchymal cells, suggesting active regeneration, while the other half showed increased extracellular collagen. The seven-day surgery piglets euthanized at 5D PO, and 1W PO showed evidence of greatly increased extracellular collagen, while some piglets had proliferating mesenchymal cells, suggesting a regenerative effort is ongoing while scar formation seems to predominate. In short, our qualitative findings suggest that the piglets lose the full myocardial regenerative potential by 7 days after birth, but greatly preserve the regenerative potential within 1 day post-partum.
| S-EPMC9404987 | biostudies-literature
Project description: Not available
| S-EPMC5881083 | biostudies-literature