CARDIOVASCULAR FLASHLIGHT
doi:10.1093/eurheartj/ehaa911 Online publish-ahead-of-print 15 December 2020
Percutaneous transmyocardial ablation of a metastatic adrenocortical carcinoma invading the interventricular septum
Xudong Xie, Yijiang Zhou, Bifeng Wu, and Xiaogang Guo*
Department of Cardiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, Zhejiang, China
* Corresponding author. Tel: +86 571-87236500, Fax: +86 571-87236707, Email: gxg22222@zju.edu.cn
+ The first two authors contributed equally to the study.
A 52-year-old woman presented with A exertional chest tightness for E F 3 months. She had undergone resec- tion of left adrenocortical adenoma 9 years ago. A 5.5 cm × 4.1 cm mass was found on echocardiography in the interventricular septum (IVS) (Panel A, B G Supplementary material online, Video P S1) that obstructed the right ventricu- lar outflow tract (Panels B and C, ® Supplementary material online, Videos 1 R S2 and S3). The mass was non- 2 homogenously enhanced on contrast C echocardiography (Panel D, Supplementary material online, Video S4) and computerized tomography 2020/7/22 .- 156pm (Panel E), and highly up took 18F-fluo- H I HE Maptophysin rodeoxyglucose on positron emission tomography (Panel F). Since its massive invasion into the IVS made complete D ℮ * surgical resection impossible, we per- formed percutaneous interventricular J K chromogranin A Melan A tumour biopsy and transmyocardial radiofrequency ablation. Under trans- 14 18 thoracic echocardiography guidance, a biopsy needle was inserted percutane- ously at the heart apex and was advanced into the IVS and then the body of tumour to obtain tissue sample. After biopsy, a radiofrequency ablation electrode needle was inserted and directed intramyocardially into the IVS and then into the tumour. The ablation power was increased from 20 W to 60 W with a duration of up to 20 min until visible hyperechoic regions were formed on the echocardiogram (Panel E, Supplementary material online, Video S5). Three rounds of ablation were performed along the centreline of the tumour. Her symptoms were significantly relieved after the procedure. Immunohistochemistry of the specimen was positive for neuroendocrine (synaptophysin, chromogranin A) and adrenocortical (Melan A) markers (Panels H-K), indicating adrenocortical carcinoma. ®
Metastatic tumours in the heart are uncommon and pose a therapeutic challenge with limited treatment options. Echocardiography- guided percutaneous radiofrequency ablation provides an effective approach to debulk the surgically non-resectable tumour.
Supplementary material is available at European Heart Journal online.
Conflict of interest: The authors have submitted their declaration which can be found in the article Supplementary Material online.
Published on behalf of the European Society of Cardiology. All rights reserved. @ The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.