Cardiac sarcomas constitute a rare group of conditions accounting for about 25% of all primary neoplasms affecting the heart. Surgery is usually a preferable therapeutic approach, although it usually has a high degree of complexity and is associated with unfavorable outcomes. The objective of this study is to report the case of a patient with a cardiac leiomyosarcoma successfully submitted to surgical excision, as well as to carry out a brief literature review about these conditions.
A 65-year-old male patient sought medical attention with complaints of asthenia and dyspnea on exertion. The patient had no comorbidities. In the initial clinical evaluation, a diastolic murmur in the mitral focus was noted. Echocardiogram revealed left atrial dilatation and a rounded mass with a heterogeneous, mobile texture, measuring 4.0 × 3.6 cm in the left atrial cavity, partially obstructing the mitral valve. Surgical resection was the chosen therapeutic approach. During the procedure, a massive left atrial mass with a smooth surface, firmly adhered to the anterior leaflet of the mitral valve and to the lower portion of the interatrial septum, was seen. In order to obtain complete resection, the mitral valve and the lower portion of the interatrial septum were resected with surgical margins. We then proceeded to the implant of a biological valve prosthesis with reconstruction of interatrial septum with bovine pericardium. There were no complications during the procedure, or during hospitalization. Subsequent histopathological analysis revealed a cellular pattern compatible with cardiac leiomyosarcoma. Patient is currently on outpatient follow-up, undergoing chemotherapy, without any symptoms or evidence of tumor recurrence on imaging tests.
In brief, the aggressive character of cardiac sarcomas hampers therapeutic approaches for these conditons, with uncertain prognosis. In this case, surgical resection performed promptly after diagnosis, avoiding the development of other complications, was associated with favorable clinical outcome in the short term.