Heart transplantation in the treatment of primary non-operable cardiac tumors

Figures

• 

  Fig. 1. Tumor of interventricular septum and right ventricle of 40/20 mm (EchoCG dated 2009). The visible part of the tumor is demarked by a red line RV – right ventricle, RA – right atrium, LV – left ventricle

• 

  Fig. 2. Gross specimen of the recipient heart containing benign tumor (leiomyoma) on the cross-sectioned surface: tumor is indicated by asterisk RV – right ventricle, LV – left ventricle

• 

  Fig. 3. Recipient heart tumor pathology study: leiomyoma: A – Thin strip of RV myocardium on the right side of the figure. The tumor has severe spreading secondary changes: sclerosis and small foci of calcification. H + E, 1.25× objective. B – The tumor is represented by fibers and cells with regular elongated nuclei without polymorphism, with α-SMA-positive immunohistochemistry. H + E, 1.25× objective

• 

  Fig. 4. Right ventricle tumor spreading to right and left atrium, and to aortic root (MRI) LV – left ventricle, AO – aorta, RV – right ventricle

• 

  Fig. 5. Orthotopic heart transplantation steps in patient with primary non-respectable malignant tumor of the heart: A – heart tumor revision after sternotomy. The visible part of the tumor is demarked by a white line. B – Explantation of the recipient heart with tumor. C – Reconstruction of neo-atrium using xenopericardium. D – Completion of orthotopic heart transplantation RA – right atrium, AO – aorta

• 

  Fig. 6. Results of stent placement in the anastomotic area between vena cava inferior and right atrium – patency in the stenosis area was restored (cavography): stent is shown by the arrow

• 

  Fig. 7. Pathology study of the recipient heart, affected by lymphoma: A – gross specimen of the recipient heart – tumor is demarked by a white line. B – Mitral valve damaged by lymphoma (asterisk). C – Fixed gross specimen of the heart (cross-section under the line of atrioventricular valves fibrous rings). Tumor (asterisk) presented by white foci replaces the myocardium of the right ventricle, invades epicardium, grows around coronary arteries, diffusely spreading in the myocardium of the left ventricle (LV). D – Microscopic picture of large B-cell lymphoma of the heart. Tumor replaces the myocardium and invades interstitium between muscle cells; tumor is presented by solid areas containing polymorphic round cells with positive immunohistochemistry for CD 20. 200× objective, H + E staining

• 

  Fig. 8. Autopsy results: A – donor heart with repaired left atrium using xenopericardium patch. Patch is shown by arrow. B and C – Patency of anastomosis between IVC and RA of the donor hear in the area of stent placement, stent is shown by arrow. D – Extensive haemodynamic necrosis (yellow areas – arrow)