Angiosarcoma of the right atrium and right ventricle

Angiosarcomas are the most common malignant tumors of the heart and may involve the atrium, ventricles, valves, and pulmonary arteries. We present images of an angiosarcoma involving the right atrium and right ventricle. A22-year-old femalepresentedwithanorexia,weight loss, dyspnea, and lower extremity swelling. A transthoracic echocardiogram revealeda mass in the right atrium (RA) and extending through the tricuspid valve into the right ventricle (RV) (Figure 1A), a distal 70% right coronary artery (RCA) lesionwithmultiple small branches supplying themass (Figure 1B). A computed tomography scan showed the mass extending into the pericardium (Figure 1C).Magnetic resonance imaging suggested that the mass invaded the myocardial wall adjacent to the right coronary artery (Figure 1D). At the time of surgery, the tumor was found to be invading through the pericardium (Figure 2A). The anterior pericardium was completely excised. Cardiopulmonary bypass was initiated with ascending aortic cannulation and cannulas placed in the superior and inferior vena cava for 2 h and 22min. The heart was arrested with antegrade cold blood cardioplegia for 44min. The tumor was densely adherent to the wall of the RA and extended through the tricuspid valve into the RV (Figure 2B). The tumor was easily removed from the RV and tricuspid valve but invaded the RA which was partially excised and reconstructed with bovine pericardium. A small remnant of tumor near