PMC8655858_01
Pre-operative images showing left giant atrial tumor and adjacent structures. (A-C) Indicate images from CTA, (D) indicates image from PET-CT, (E,F) indicate images from 3D printing model. Red asterisks indicate left atrial tumor.
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F1
Cardiac computed tomographic angiography (CTA) (Figures 1A-C) showed an 88 x 76 mm large cardiac mass with a broad base involving the atrial septum and the anterior left atrial wall, nearly filled the entire left atrium. The right pulmonary vein orifices and the mitral valve were associated with the tumor. 18F-fluorodeoxy-glucose positron emission tomography-computed tomography (PET-CT) scan demonstrated that left atrial tumor was hypermetabolic tumor activity without signs of any distant metastases (Figure 1D).
Intraoperative images showing the key surgical steps of cardiac autotransplantation. (A) The aorta was divided and the roof of left atrium was then opened to explore the tumor. (B) The heart with tumor was excised and the tumor was removed ex vivo. (C) The pericardial cavity after the resection of the heart. (D) The tumor with broad base was completely resected. (E) Bovine pericardial patch was used to reconstruct the atrial septum and the anterior wall of left atrium. (F) Reimplantation of the heart to the body. (G) Self-constructed bovine pericardial tube. SVC, superior vena cava; IVC, inferior vena cava; AMV, anterior mitral valve; PMV, posterior mitral valve.
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F2
The heart was excision (Figures 2A-C) and the tumor were removed (Figure 2D). The repair of the excised septum and anterior left atrial wall was performed with two bovine pericardium patches (Figure 2E). Reimplantation of the heart is similar to a bicaval orthotopic cardiac transplant (Figure 2F). Self-constructed bovine pericardial tube has been used as a graft to complete the re-anastomosis of inferior vena cavae to alleviate tension (Figure 2G).