Presumed Primary Cardiac Angiosarcoma With Atrioventricular Groove Rupture and Right Coronary Artery Compromise: A Case Report and Literature Review

Figures

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  FIGURE 1. Admission 12‐lead electrocardiogram demonstrating sinus rhythm with narrow QRS complexes, low‐to‐borderline limb‐lead voltage, and nonspecific ST–T changes, without diagnostic ST‐segment elevation; interpretation of some precordial leads is limited by baseline artifact.

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  FIGURE 2. Chest radiograph at presentation showing an enlarged cardiac silhouette.

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  FIGURE 3. Cardiac magnetic resonance imaging. (A) Balanced steady‐state free precession four‐chamber cine showing an ill‐defined infiltrative lesion centered on the lateral right atrium (RA)/right atrioventricular groove, with extension toward the right ventricle (RV). The yellow asterisk marks tumor; the solid arrow marks the suspected wall‐disruption site, and the dashed arrow shows the expected anatomic course of the RCA in the groove (the artery is not directly resolved on this frame). (B) T2‐weighted STIR black‐blood image showing a high‐signal infiltrative mass (asterisk) and left pleural effusion. (C) LGE image showing heterogeneous tumor and adjacent pericardial enhancement (asterisk). No dynamic sequence demonstrating active contrast extravasation was available. LGE, late gadolinium enhancement; RCA, right coronary artery; STIR, short‐tau inversion recovery.

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  FIGURE 4. Preoperative transesophageal echocardiographic still showing a pseudoaneurysm‐like protrusion at the lateral right atrial/right atrioventricular‐groove wall (yellow arrow). Continuous internal flow was documented during the examination, although the archived still available for publication does not include color Doppler.

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  FIGURE 5. Coronary angiography. (A) Contrast enters a fistulous communication between the right coronary artery and right atrium (yellow arrow). (B) Left coronary injection shows collateral‐dependent retrograde filling of the distal right coronary artery (yellow arrow).

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  FIGURE 6. Intraoperative photograph demonstrating the infiltrative lesion extending from the right atrium to the right ventricle. The asterisk marks the tumor, and the arrow marks the right atrioventricular‐groove rupture identified at operation.

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  FIGURE 7. (A) Surgical field after subtotal tumor debulking, showing right atrial (RA) and right ventricular (RV) wall defects (labeled arrows). (B) Gross view of the excised tumor fragments.

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  FIGURE 8. Intraoperative view after bovine pericardial patch reconstruction of the right heart and saphenous‐vein‐graft bypass to the posterior descending artery.

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  FIGURE 9. Approximately 2‐month postoperative transesophageal echocardiographic transgastric view showing the reconstructed right‐sided cardiac chambers. RA, right atrium; RV, right ventricle; TV, tricuspid valve. The formal report documented a fixed 20 × 22‐mm hypoechoic right atrioventricular‐groove lesion; this still is included for reconstructed anatomy and does not provide an independent lesion measurement.