Key result
Multimodal surgery and carbon-ion radiotherapy yield temporary tumor control with ~20-month survival in cardiac intimal sarcoma.
Why the study?
Cardiac intimal sarcoma usually presents as an isolated left atrial mass, whereas pan-left-heart involvement producing simultaneous inflow and outflow obstruction is rare.
Case Report (n=1)
Cardiac intimal sarcoma can cause simultaneous functional mitral stenosis and dynamic left ventricular outflow tract obstruction via a 'whiplash motion' of a papillary-muscle tumor component, requiring prosthetic valve selection to account for subsequent multimodality oncologic therapy.
Answers are grounded in this paper and cite their sources.
Rare dual obstruction from intimal sarcoma may prompt broader differential in atypical left-heart masses; leaves open optimal prosthetic valve choice with radiotherapy.
BACKGROUND: Cardiac intimal sarcoma (CIS) usually presents as an isolated left atrial mass; pan-left-heart involvement producing simultaneous inflow and outflow obstruction is rare. CASE SUMMARY: A 43-year-old man presented in acute heart failure (B-type natriuretic peptide 948.8 pg/mL; right ventricular systolic pressure 59 mm Hg). Imaging showed a tumor in the left atrium and ventricle: an atrial mass infiltrated the mitral leaflet, causing functional mitral stenosis, whereas a mobile papillary-muscle component showed a "whiplash motion," prolapsing into the left ventricular outflow tract and protruding through the aortic valve in systole. Emergency debulking and mechanical mitral valve replacement followed; histopathology confirmed CIS (mouse double minute 2 homolog/cyclin-dependent kinase 4 positive, mouse double minute 2 homolog-amplified). Although adjuvant carbon-ion radiotherapy provided temporary control, the patient died 20 months later. DISCUSSION: We propose the "whiplash motion" sign and highlight the trade-off between mechanical-valve durability and bleeding risk during thoracic radiotherapy. TAKE-HOME MESSAGE: CIS can cause dual left-heart obstruction through multicomponent tumor dynamics; prosthetic valve choice should anticipate multimodality oncologic management.
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Oshiro et al. (2026) conducted a case report in Cardiac intimal sarcoma with functional mitral stenosis and dynamic left ventricular outflow tract obstruction (n=1). Emergency debulking, mechanical mitral valve replacement, and adjuvant carbon-ion radiotherapy was evaluated on Survival / tumor control. Emergency debulking, mechanical mitral valve replacement, and carbon-ion radiotherapy provided temporary control of pan-left-heart cardiac intimal sarcoma before death at 20 months.
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