Autotrasplante cardiaco en el tratamiento quirúrgico de tumores cardíacos primarios. Caso clínico.

Resumen

HEART AUTOTRASPLANTATION FOR THE TREATMENT OF  A RHABDOMYOSARCOMA OF THE LEFT VENTRICLE. REPORT OF ONE CASE

Heart autotrasplantation is an exceptional surgical technique used in the treatment of uncontrolled cardiac arrhythmias and  primary unresectable cardiac tumors. We report a 28 years old male with a rhabdomyosarcoma of the left ventricle, localized in the lateral and posterior wall, which involved the mitral valve and circumflex artery. After a complete study ruling out dissemination of the tumor, the patient was operated. Surgical exploration determined the unresectabilility of the tumor with the heart in situ. Therefore, the heart was explanted, preserving the right atrium and coronary sinus for re-implantation. Fifty percent of the mitral valve and  the circumflex artery from its origin, were resected due to tumor infiltration. The heart was reconstructed with bovine pericardium and a mechanical valve was implanted in the mitral position. Afterward, the heart was implanted again following the same sequence as in bicaval transplantation, followed by a double bypass grafting to the distal circumflex territory. The patient had no significant complications and after nine months of follow up, there was no evidence of local recurrence. In the fourth postoperative month, a subcutaneous mass in the left thigh that was considered a metastasis without histological confirmation appeared. The lesion disappeared with radio and  chemotherapy.