Conclusion
Malignant lymphoma is generally responsive to chemotherapy, with a reported response rate of 79% [2]; therefore, chemotherapy is often selected as a first-line treatment for PCL [3]. However, chemotherapy requires a large infusion volume, is associated with a likelihood of pulmonary tumor embolization, and carries a risk of cardiac tamponade due to tumor hemorrhage. Furthermore, in cases less responsive to chemotherapy, a growing tumor could cause hemodynamic instability or fatal cardiac arrhythmia [3]. Our patient had signs of heart failure (exertional dyspnea and lower limb edema), and his tumor occupied most of the right heart and caused tricuspid stenosis. Therefore, we performed tumor resection as quickly as possible to avoid fatal cardiac events.
Partial tumor resection to relieve the tricuspid stenosis might have been enough to prevent fatal hemodynamic collapse [5]. However, the tumor involved the anterior and posterior tricuspid leaflets and was too fragile to be sutured with biological materials. Therefore, complete resection of the PCL was required to ensure security of the stitches within the cardiac tissue. Although the excised end of the tumor was pathologically positive, subsequent chemotherapy showed promising efficacy; therefore, two-stage treatment for this patient’s PCL was a justified strategy [6].
In conclusion, we successfully performed complete surgical tumor resection and reconstruction of the right atrium and right ventricle using a bovine pericardial patch for a huge PCL filling the right heart. Urgent surgery enables timely administration of postoperative chemotherapy without heart failure.
Acknowledgment: We thank Angela Morben, DVM, ELS, from Edanz Group (https://en-author-services.edanzgroup.com/ac), for editing a draft of this manuscript.
Author contribution statement: Takura Taguchi was responsible for acquisition of the data and writing of the original manuscript. Satsuki Fukushima, Shin Yajima, and Tomoyuki Fujita made substantial contributions to the conception of the study and design of this report and assisted with critical revision of the manuscript. All authors provided final approval of the version to be published.