A Retrospective Analysis of AngioVac Outcomes at a Tertiary Care Center.

Background: The AngioVac system is a vacuum aspiration device approved for removal of right-sided cardiac thrombi. It has also been used for management of right-sided endocarditis in selected cases. Retrospective case series have reported high success rate and acceptable 30-day mortality, but there is limited data regarding outcomes beyond the immediate postoperative period. The purpose of this study is to describe our institution's experience with the AngioVac system for thrombus, vegetation, and tumor removal with a significant improvement over previously reported 1-year survival rates. Methods: A retrospective review of AngioVac cases performed at our tertiary care center from 2016-2022 was done. From 2016-2022, 23 patients were identified, and their outcomes are described. Results: Our review demonstrates 81.8% procedural success, 100% procedure survival, 90.9% survival to discharge, and 81.8% 30-day survival rates. One-year survival rate was 72.7%. Complications including an 18.2% rate of new vasopressor use, 54.5% rate of transfusion requirement, and 4.5% rate of acute renal failure requiring hemodialysis were identified. Intraprocedural embolization occurred in 1 case requiring venoarterial extracorporeal membrane oxygenation support and thrombectomy. One case was converted to open surgical intervention. Conclusions: Our review further supports the safety and efficacy of minimally invasive vacuum-assisted aspiration systems beyond the immediate postoperative period in intracardiac thrombus, tumor, and right-sided infective endocarditis. Our institution's experience emphasizes a team-based approach including interventional cardiology and cardiothoracic surgery with a standardized imaging approach with transesophageal echocardiogram. Future guidelines are needed to include an algorithmic approach to intracardiac masses.

Mantle Cell Lymphoma With Cardiac Involvement Presenting as Complete Heart Block.

A 50-year-old woman presented with complete heart block on electrocardiogram. Echocardiogram revealed an intracardiac mass with extensive cardiac involvement. The patient was diagnosed with mantle cell lymphoma, confirmed via lymph node biopsy. Pacemaker implantation and chemotherapy were initiated, with subsequent improvement noted. This showcases an unusual manifestation of intracardiac metastasis with conduction system infiltration.

The MICHIGAN Procedure: Mass extraCtIon from the Heart FacIlitated by ONOCOR GlobAl embolic protectioN Device.

Intracardiac masses present a challenging diagnostic and therapeutic dilemma and are associated with an increased risk of complications, such as embolic events and obstructive symptoms. We report a novel procedure using an ONOCOR device through subclavian access that acted as a full-body protection device as well as a retrieval device.

Primary cardiac synovial sarcoma originating from the atrial septum and associated pulmonary infarction: a case report.

BACKGROUND: Primary cardiac synovial sarcoma is a rare condition with limited treatment options for advanced stages. Surgery and chemotherapy are currently the mainstay treatments; however, survival rates remain low. CASE PRESENTATION: A 64-year-old woman presenting with symptoms of chest tightness and shortness of breath was found to have an obstructive right atrial mass, along with pulmonary infarction and metastasis. She was ultimately diagnosed with advanced primary cardiac synovial sarcoma. Following surgery, the patient's symptoms improved, and she underwent chemotherapy and anti-angiogenic therapy, but unfortunately, her survival time was only 8 months. CONCLUSION:  This case report aims to enhance clinicians' understanding of the diagnosis and treatment of primary cardiac synovial sarcoma. Enhancing both survival outcomes and quality of life in individuals with primary cardiac synovial sarcoma continues to present a significant challenge.

Combining Novel Thrombectomy Devices for Intracardiac Mass Extraction: The Kong and Godzilla of Mass Extraction.

Transcatheter extraction of an intracardiac mass is a newer approach that may lead to nonsurgical treatment of complex cardiac masses. We present a case in which thrombectomy devices were combined to extract a right atrial mass, which highlights new frontiers in the treatment of complex transcatheter mass extraction. The combined use of two transcatheter thrombectomy devices (Kong and Godzilla) may provide a powerful addition to the existing armamentarium.

Spontaneous Migration of Ventriculoperitoneal Shunt Into the Right Heart and Pulmonary Vasculature.

A 73-year-old woman with ventriculoperitoneal (VP) shunt presented for stress echocardiogram for evaluation of chest pain. Transthoracic echocardiogram revealed an incidental right heart mass representing a migrated VP shunt. This case highlights the role of multimodality cardiac imaging in diagnosing right heart masses and the multidisciplinary approach to management.

An Unusual Case of Cardiac Mass: A Multimodal Approach in Diagnosis and Treatment.

Diagnosing intracardiac masses poses a complex, multimodal challenge. We present the case of a 72-year-old woman with a history of rheumatic fever leading to mitral stenosis and a previous mitral valve commissurotomy who reported fatigue, weakness, and palpitations over the past three months. Echocardiography revealed a tumor (53 × 40 mm) in the enlarged left atrium, attached by a wide base to the left atrium wall, exhibiting variable densities. Computerized tomography identified a heterodense mass (53 × 46 × 37 mm) with similar attachments. Angiography showed two branches from the circumflex artery intricately associated with the mass. Despite unsuccessful embolization of the mass' blood supply, surgical intervention including mitral valve replacement, tricuspid valve annuloplasty, and tumor removal was pursued. Pathohistological analysis confirmed the mass as a thrombus. During the postoperative follow-up, the patient presented with no complaints. Follow-up echocardiography indicated the normal function of the mechanical mitral valve prosthesis and the absence of intracardiac masses. While it remains unknown whether this neovascularization is specific to patients with severe mitral valve disease, this case highlights the diagnostic challenges of differentiating between thrombi and tumors in the context of mitral valve disease. It illustrates the critical role of multimodal imaging in elucidating the anatomical and functional relationships within the heart, thereby guiding accurate diagnosis and effective treatment.

Inverted left atrial appendage mimicking potential left atrial thrombus in an infant following cardiac surgery: a case report.

Background: Inverted left atrial appendage (iLAA) is an infrequent complication following cardiac surgery, seen both in children and adults. Following a recent encounter, this review article is aimed to remind the reader about its occurrence, clinical manifestations, differential diagnoses, and management options. Case summary: A 3-month-old baby underwent successful surgical repair of a large ventricular septal defect. Intraoperative epicardial echocardiogram at the end of the case demonstrated an unexpected left atrial mass, raising suspicion of a thrombus adjacent to the mitral valve. Urgent re-establishment of cardiopulmonary bypass and exploration of the left atrium did not reveal a thrombus, but this was subsequently identified as an iLAA. This completely resolved after manual external reduction of the appendage. Discussion: Published literature is confined to case reports only, with most cases observed post-operatively, but some occurring spontaneously. Awareness of this unusual manifestation is particularly important in the intraoperative period as it can usually be addressed without the need for further cardiopulmonary bypass.

Percutaneous Vacuum-Assisted Aspiration of Mobile Caseous Mitral Annulus Calcification.

A 68-year-old woman presented with an incidentally found intracardiac mass. Transesophageal echocardiography (TEE) showed a 26 × 8 mm mobile mass attached to a calcified posterolateral mitral annulus. The mass was removed with a commercially available percutaneous catheter system using cerebral embolic protection and TEE guidance. The pathologic examination showed caseous mitral annular calcification.

Percutaneous Intracardiac Mass Extraction in High Surgical-Risk Patients.

Large intracardiac masses including tumors, thrombi, and vegetations result in detrimental embolic or obstructive sequelae and present a management dilemma. Open heart surgery, the traditional approach, may not be an option for many patients with a prohibitive surgical risk due to multiple comorbidities. Recently, percutaneous options have emerged with reported success in extracting such intracardiac masses. A 42-year-old female with history of advanced primary sclerosing cholangitis with decompensated liver cirrhosis causing ascites and variceal bleed presented to the emergency department with fatigue, subjective fevers, chills and melena. Laboratory results revealed neutrophil-predominant leukocytosis and normocytic anemia, and blood cultures were positive for Candida albicans. Electrocardiography showed sinus tachycardia. Chest X-ray was unremarkable. She underwent packed red blood cell transfusion and esophageal banding for variceal bleeding. Transthoracic echocardiogram revealed normal left ventricular ejection fraction and no wall motion abnormalities. A right atrial mobile mass measuring approximately 1.0 × 3.0 cm was noted. Multidisciplinary heart team discussion concluded that while the mass posed a high embolic risk, the patient had a prohibitive risk for surgical intervention. Successful percutaneous removal of the mass using Penumbra system device (Penumbra Incorporated, Alameda, CA) was accomplished. This case report details the procedure and outcomes, as well as presents a literature review.

An Intracardiac Atrioventricular Vena Caval Mass: A Case Report.

Cardiac tumors (CTs) and intracardiac masses are rare, with an incidence of 1 per 2 million people annually. We present a case of an intracardiac mass where the patient exhibited progressive lower extremity swelling, night sweats, and diarrhea. Computed tomography of the chest with intravenous contrast revealed a sizable intracardiac mass with mixed attenuation and signs of metastatic lesions, suggesting a malignant process. This case stands out due to its uncommon presentation, considerable size, and extension from the right atrium into the right ventricle and the inferior vena cava. Although the exact etiology remains unclear because of the absence of a biopsy, it was presumed to be a type of sarcoma. Owing to significant cardiac obstruction, the patient's condition worsened rapidly, culminating in a fatal outcome mere days after the initial presentation. While there are multiple approaches to identify and treat CTs, their propensity to grow quietly until they reach a size large enough to cause fatal symptoms restricts opportunities for early detection and treatment.

Rapid daily expansion of highly mobile intracardiac calcified tissue: a case report.

Background: A calcified amorphous tumour (CAT) is a non-neoplastic mass lesion arising within the cardiac chamber. CATs are rare but are a common cause of organ embolism. In the present study, we experienced a case of an intracardiac mass with calcification that, in contrast to a typical CAT, suddenly appeared and rapidly expanded without an inflammatory response based on pathological findings. Case summary: A 58-year-old Japanese man undergoing peritoneal haemodialysis had a high-echoic mobile mass (15 × 6 mm), which was not visible on the transthoracic echocardiography (TTE) approximately a month earlier, in the left ventricular outflow tract noted on TTE performed during a close examination for fever. Although multiple blood cultures were negative, ampicillin/sulbactam and ceftriaxone were initially administered because of suspected blood culture-negative endocarditis. The mass rapidly enlarged (22 × 5 mm) over the following days. A CAT was suspected and resected based on imaging findings with calcification; however, the pathological findings did not indicate inflammation and fibrin that are typically found in CATs. Echocardiography performed 12 months after the resection showed no recurrence. Discussion: This intracardiac calcified tissue had several similar features to a CAT. However, the initial presentation, enlargement rate, and pathological features of the tissue differed from that of a typical CAT. Although it is unknown whether this mass is a subtype of CAT, when an intracardiac calcified tissue is detected using an imaging test, careful follow-up or early surgical resection should be considered given the possibility of rapid tissue enlargement and embolism caused by the mass.

Case Report: Right atrial organized thrombus three years after tricuspid annuloplasty.

Background: Occurrence of right atrial masses, especially in patients with history of cardiac surgery, is rare. Differential diagnosis between malignant and non-malignant aetiologies might be cumbersome, and surgery is often required to prevent complications or disease evolution. Case: We report the case of a 16-year-old girl from a rural area of Sudan, who underwent surgery for a modified De Vega's tricuspid annuloplasty, and mitral and aortic valve replacement with mechanical prostheses. The patient was on regular follow-up but demonstrated a poor compliance to anticoagulation therapy with a time in therapeutic range between 52% and 20%. She remained asymptomatic, but a right atrial mass was diagnosed by transthoracic echocardiography during a follow-up visit 41 months after the first operation. Surgical removal of the mass revealed an organized thrombus arising from the point where the Prolene stitches for the tricuspid annuloplasty were previously passed. The patient recovered from surgery, was discharged home on post-operative day 10 and the first follow-up visit at 30 days after discharge confirmed a good clinical status and a normal transthoracic echocardiography (TTE). Conclusions: This case report describes the diagnostic and therapeutic work-out of a thrombus formation on the suture lines of a tricuspid annuloplasty. Moreover, it highlights the importance of a strict and long follow-up after valvular surgery and of the adherence to anticoagulation therapy, especially for patients living in rural areas of developing countries.

Unusual mass in the heart: A case report.

Carcinoma lung is a concerning cause of mortality worldwide. Approximately half of the cases are metastatic at diagnosis and uncommon metastatic sites confer a worse prognosis. Intracardiac metastasis from lung cancer is rare and limited to a few case reports. The authors describe the case of a 54-year female with left ventricular cavity mass as one of the rarest presentations of lung malignancy. She presented to the cardiology outpatient department with a history of progressive dyspnea for the last two months. Her 2D echocardiogram showed a large heterogeneous mass in the left ventricle cavity along with gross pericardial and pleural effusion. CT guided lung biopsy revealed adenocarcinoma of the lung. The patient was started on tablet geftinib along with other supportive therapy, while awaiting reports of next generation sequencing (NGS) for mutation analysis and immunohistochemistry. However, the patient's condition rapidly worsened and she succumbed to death within one week of hospital admission. Cardiac metastasis is one of the rarest sites for lung cancer spread. Intracavitary metastasis as in our case is an extremely rare presentation. Treatment is not yet well defined for such cases and it carries a poor prognosis despite available therapies. This case required multidisciplinary approach with involvement of cardiologist, oncologist, pulmonologist and intensivists. Further research is required to help define better treatment options.

The Simplified Extraction of Atrial Tumor With Targeted Loop Electricity (SEATTLE) Procedure.

The removal of intramyocardial masses has long been thought of as a surgical procedure and is generally reserved for patients with obstructive symptoms when the mass is thought to be benign. Thus, many patients who are incidentally diagnosed with intracardiac masses are either subjected to protracted follow-up with serial imaging awaiting tumor growth before surgical excision is ultimately offered. We report a novel procedure in which a 54-year-old man with an atrial myxoma underwent successful percutaneous resection using electrosurgery followed by removal with a novel endovascular retrieval system. This approach provides an alternative to either surgical excision or watchful waiting in patients with small- to medium-sized intracardiac tumors. (Level of Difficulty: Advanced.).

Calcified Right Atrial Thrombus With Near-Systemic Pulmonary Pressures in a Morbidly Obese Patient: A Clinical Conundrum.

Intracardiac masses are not uncommon, but a calcified right atrial thrombus (CRAT) is an exceedingly rare entity and often poses a diagnostic and therapeutic dilemma. We discuss the case of an incidentally noted CcRAT in a 40-year-old man presenting with progressive dyspnea. We further review the literature on the subject, highlighting the need for an individual patient-centred care plan.