A Case of Primary Cardiac Sarcoma with Brain Metastasis

Primary cardiac sarcomas are an extremely rare disease, which are usually diagnosed late, as they seldom display symptoms until they obstruct the cardiac outflow or spread to distant organs. We report the case of a 57-year-old female presenting symptoms of a brain tumor, such as dizziness and visual disturbance. Further evaluations revealed multiple brain metastatic tumors, and a cardiac tumor as the primary lesion. Histological examination of the resected cardiac tumor showed cells of a poorly differentiated sarcoma. The current literature regarding incidences, diagnosing techniques, treatment strategies and prognosis of primary cardiac sarcomas are briefly reviewed with our case report.

Total Occlusion of Left Main Coronary Artery by Dilated Main Pulmonary Artery in a Patient with Severe Pulmonary Hypertension

A 34-year-old woman was admitted to the hospital because of recently aggravated right heart failure without angina for 5 months. When she was 25 years old, patch repair with Polytetrafluoroethylene (PTFE) was performed for the secondum type of atrial septal defect (ASD) with moderate pulmonary hypertension. The chest PA, echocardiography and cardiac catheterization at current admission revealed Eisenmenger syndrome without intracardiac shunt. Chest CT scan with contrast revealed markedly dilated pulmonary trunk, both pulmonary arteries and concave disfigurement of the left side of the ascending aorta suggesting extrinsic compression, as well as total occlusion of the ostium of the left main coronary artery that was retrogradly filled with collateral circulation from the right coronary artery. The coronary angiography showed normal right coronary artery and the collaterals that come out from the conus branch to the mid-left anterior descending artery (LAD) and that from distal right coronary artery to the left circumflex artery (LCX) and to the distal LAD, respectively. On aortography, the left main coronary artery was not visualized with no stump, suggestive of total occlusion of the ostium of the left main coronary artery. From our experience, it is possible to say that the occlusion of the ostium of the left main coronary can be induced by the dilated pulmonary artery trunk due to ASD with pulmonary hypertension and that, if the ASD closure was too late, the narrowing or obstruction of the left coronary artery could not be resolved even after operation owing to irreversible pulmonary hypertension.