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\begin{document}

\title{Surgical treatment of 2 cases of primary cardiac malignant tumor}



\author[1]{pengying zhao}%
\author[1]{ruisheng liu}%
\author[1]{dianwei cheng}%
\author[1]{wei sun}%
\author[1]{bing song}%
\affil[1]{Lanzhou University First Affiliated Hospital}%


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  \date{May 05, 2024}


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\begin{abstract}
Cardiac tumors are a rare disease in clinical practice. Two patients
with primary cardiac malignancies were admitted to our hospital from May
2020 to July 2020. The first patient`s heart tumor is non-Hodgkin's
lymphoma, which originated in the right atrium and invaded part of the
right atrium and superior vena cava. The tumor was completely removed
and the right atrium and superior vena cava were reconstructed after
surgery. The prognosis of the patients after chemotherapy is fair. The
second patient's tumor also originated in the right atrium, which was an
epithelioid hemangioendothelioma, it was highly malignant and had a wide
range of tumor invasion. The right atrium, left atrium, right ventricle,
aortic root, and superior and inferior vena cava were all involved and
could not be completely surgically removed, so the patient's prognosis
is poor.%
\end{abstract}%



\sloppy


\textbf{Surgical treatment of 2 cases of primary cardiac malignant
tumor}

Pengying Zhao\textsuperscript{1}, Ruisheng Liu\textsuperscript{2},
Dianwei Cheng\textsuperscript{3}, Sun Wei\textsuperscript{4}, Song
Bing\textbf{*}

Corresponding Author: Song Bing

Author information: Department of Cardiovascular Surgery, Lanzhou
University First Affiliated Hospital, Lanzhou 730000, China.

E-mail: 987872294@qq.com; 18909427201@163.com

\begin{CJK}{UTF8}{gbsn}\textbf{【Keywords】} \end{CJK}\selectlanguage{english}cardiac malignancy; surgical treatment; prognosis

\textbf{Introduction}

Cardiac tumors are a rare disease in clinical practice. Generally, they
can be divided into primary cardiac tumors and secondary cardiac tumors
according to their sources; benign and malignant according to their
degree of differentiation. According to statistics, the clinical
incidence of primary cardiac tumors is about 0.02\%, of which 25\% are
primary malignant cardiac tumors \textsuperscript{{[}1-2{]}}. Primary
malignant cardiac tumors have poor clinical manifestations and high
misdiagnosis rates. Some patients have tumors that are difficult to
surgically remove and have poor clinical
prognosis\textsuperscript{{[}3{]}}.

\textbf{Method}

Two patients with primary cardiac malignancies were admitted to our
hospital from May 2020 to July 2020.,Both patients were treated with
surgery,but one of the patients was difficult to remove due to
extensive tumor invasion. The reports are as follows(We have obtained
the patient's verbal informed consent):

\textbf{Case 1} , the patient, male, 67 years old, was admitted to the
hospital for '' Chest pain for 1 week''. Physical examination: T 37.5,
BP 128/76mmHg, P 89 times/min. The heart circle is slightly enlarged,
the heart rate is 89 beats/min, the rhythm is uniform, and the 2/6
diastolic murmur can be heard in the precordial area. Videography
examination: Echocardiogram (Figure 1-1) indicates: the right atrium
occupies space, consider myxoma. Chest CT (Figure 1-2) suggests that the
right atrium occupies a large space, and myxoma should be considered.
Laboratory examination: Ferritin SF (tumor marker) 745.7ng/ml (reference
range 30-4007ng/ml). Clinical diagnosis: right atrium space-occupying
lesions. After perfecting the preoperative preparation, surgical
treatment under general anesthesia and low-temperature cardiopulmonary
bypass (conventional median thoracotomy, ascending aorta, superior and
inferior vena cava to establish cardiopulmonary bypass. Block the
ascending aorta, induction of cardiac arrest, and a right atrial
incision, a size of about 55mm\selectlanguage{ngerman}×50mm×45mm tumors, irregular in shape,
lobulated, tough in texture, tightly adhered to part of the right atrium
wall and involved in part of the superior vena cava, surrounded by
thrombosis, the tumor is infiltrating growth, suspected of cardiac
malignancy. Carefully explore the surrounding tissues of the tumor,
complete removal of the tumor together with part of the right atrium and
superior vena cava tissue, remove the thrombus around the superior vena
cava, and send the tumor tissue for pathological examination. Take the
calf pericardial patch to reconstruct the right atrium and superior vena
cava. Open circulation, heart automatically resumes, routine hemostasis
and chest shut). The final tumor histopathological examination results
(1-3) suggest that: morphology and immunohistochemistry support
non-Hodgkin's lymphoma, diffuse large B-cell lymphoma (from non-germinal
centers), excluding double-hit lymphoma. After the operation, targeted
chemotherapy was given to the patient's pathological and
immunohistochemical results. After the operation, the results of
Echocardiogram showed normaly (Figure 1-4). At present, follow-up to 3
months after surgery, the patient's general condition is fair, and no
recurrence is seen.

\textbf{Case 2} , the patient, male, 28 years old, was admitted to the
hospital mainly because of ''chest tightness and shortness of breath for
3 days''. Physical examination: T 37.8\selectlanguage{english}, BP 120/78mmHg, P 85 times/min.
Enlarged heart circle, heart rate 92 beats/min, regular rhythm, and 2/6
diastolic murmurs can be heard in the tricuspid auscultation area.
Videography examination: Echocardiogram (Figure 2-1) indicates that the
right atrium occupies space, the tumor is closely related to the right
atrium wall, and part of the tumor reciprocates to the right ventricle
through the tricuspid valve with the cardiac cycle; the tricuspid valve
is refluxed in a moderate amount. Chest CT (Figure 2-2) suggests: the
right atrium is enlarged and mixed with high-density shadows, consider
tumorous lesions; right pleural effusion. Cardiac MRI (Figure 2-3)
indicates: the right atrium is large, the right atrium wall is locally
broken, the pericardium and the ascending aorta are locally invaded, and
malignant tumors are considered (the possibility of angiosarcoma is
high); Indoor blood flow is stagnant; right pleural effusion. Laboratory
examination: Ferritin SF (tumor marker) 1032ng/ml (reference range
30-4007ng/ml). No obvious abnormalities were found in other inspections
and inspections. Clinical diagnosis: right atrium space-occupying
disease, tricuspid regurgitation, pericardial effusion, pleural
effusion. After perfecting the preoperative preparations, he would like
to undergo surgical treatment. During the operation, a large amount of
bloody pericardial effusion was seen when the pericardium was opened.
The right atrium, the root of the aorta of the left atrium, and part of
the surface of the right ventricle showed protruding cauliflower masses
(Figure 2-4). Hard masses can be seen in the ventricle and aortic roots.
The tumor has a wide range of invasion and cannot be surgically removed.
A small amount of specimens were taken for pathological examination.
Than we gave up the operation, closed the chest. The histopathological
results (Figure 2-5) show: angiogenic malignant tumor, consider
epithelioid hemangioendothelioma.

\textbf{Discussion}

Primary cardiac malignancies are clinically rare, and histological
sources mainly include sarcoma, malignant mesothelioma, malignant
mesenchymal tumor, lymphoma, etc., among which sarcoma is the most
common. The atrium is the most common site for tumors, and 89\% of
primary cardiac malignancies originate in the right
atrium\textsuperscript{{[}4{]}}. The clinical manifestations of patients
mainly depend on the location, size, local infiltration and distant
metastasis of the tumor. Dyspnea is the most common clinical symptom. In
addition, pericardial effusion, chest tightness, arrhythmia, refractory
heart failure, and tumor may also occur Embolism caused by
shedding\textsuperscript{{[}5{]}}, clinical manifestations lack
specificity, easy to misdiagnose. At present, the main examination
methods include cardiac ultrasound, CT, MRI, digital subtraction
angiography (DSA), cardiovascular tomography, pericardiocentesis, and
surgical exploration. Generally, cardiac malignant tumors often appear
as tumors and normal hearts on imaging examinations. The boundaries of
the atrioventricular cavity are unclear, the base of the tumor is wide,
and the activity is small \textsuperscript{{[}6{]}}. At present, for the
treatment of cardiac malignant tumors, most scholars believe that when
the malignant cardiac tumor is diagnosed clearly and there is no distant
metastasis, in principle, the tumor should be removed as soon as
possible\textsuperscript{{[}7{]}}. However, some primary cardiac
malignant tumors have a large invasion range, severe adhesion to
surrounding tissues, difficult operation, and many postoperative
complications. These patients often have a short long-term survival time
and a poor prognosis. Therefore, we need to combine other treatments,
including adjuvant chemotherapy and radiotherapy, in order to improve
the prognosis of patients.

\textbf{Conclusion}

The first patient in this article, his heart tumor is non-Hodgkin's
lymphoma, which originated in the right atrium and invaded part of the
right atrium and superior vena cava. The tumor was completely removed
and the right atrium and superior vena cava were reconstructed after
surgery. The prognosis of the patients after chemotherapy is fair, and
there is no recurrence in the short-term follow-up, and the results of
the medium- and long-term follow-up are expected. The second patient in
this article, his tumor also originated in the right atrium, which was
an epithelioid hemangioendothelioma, it was highly malignant and had a
wide range of tumor invasion. The right atrium, left atrium, right
ventricle, aortic root, and superior and inferior vena cava were all
involved and could not be completely surgically removed, so the
patient's prognosis is poor. For such patients, we need to perform
careful imaging evaluation before surgery, perform cardiac angiography
if necessary, and be cautious in surgical operations.

\textbf{References:}

{[}1{]} Zhu Xiaodong, Zhang Baoren. Cardiac Surgery. Beijing: People's
Medical Publishing House, 2007:1195-1202. {[}2{]} Liu Kaiyu, Tian Hai,
Jiang Shulin. Diagnosis and surgical treatment of cardiac malignancies.
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014,
8, 21(4): 461-464. {[}3{]} Reardon MJ, Walkes JC, BenjaminR. Therapy
insight: malignant primary cardiac tumors\selectlanguage{english}[J\selectlanguage{english}]\selectlanguage{english}. Nat Clin Pract
Cardiovasc Med, 2006, 3(10):548-553. {[}4{]} Bouma W, Lexis CP, Willems
TP, et al. Successful surgical excision of primary right atrial
angiosarcoma\selectlanguage{english}[J\selectlanguage{english}]\selectlanguage{english}. Cardiothorac Surg, 2011, 6(9): 47-58. {[}5{]} Zhang
Li, Wang Hong, Wan Yixin. Two cases of cardiac malignant tumors treated
with lung shadows and literature review. Journal of Practical Oncology,
2019, 5: 457-460. {[}6{]} Zhang Caihong, Zhang Wenhui, Li Quanliang, et
al. Analysis of 34 cases of cardiac tumors diagnosed by color Doppler
ultrasound. Chinese Journal of Ultrasound Diagnosis, 2001, 2(4): 23-24.
{[}7{]} Chen Changcheng, Liu Shuo, Xu Lili, et al. Surgical efficacy of
primary cardiac malignancies. Journal of Cardiopulmonary and Vascular
Disease, 2015, 4:265-269. {[}8{]} Gan Ling, Wang Wei, Liu Shanjun, et
al. Preliminary study on myocardial contrast-enhanced performance of
cardiac malignant tumors. Journal of Clinical Ultrasound Medicine, 2018,
5: 302-305.\selectlanguage{english}
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