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Ann Thorac Surg 1996;61:279-280
© 1996 The Society of Thoracic Surgeons

Correspondence

The Surgical Challenge of Primary Pulmonary Artery Sarcoma

Claus Bartels, MD, Matthias Bechtel, Christoph Winkler, MD, Svante Horsch, MD

Department of Vascular Surgery, Krankenhaus Porz am Rhein, Teaching Hospital University of Cologne, Urbacher Weg 19, 51149 Cologne, Germany

To the Editor:

Doctor Anderson and colleagues [1] ought to be congratulated for presenting a unique series on surgical treatment of primary pulmonary artery sarcomas, which includes 6 cases from a large selected population referred to the expertise of their unit for evaluation and treatment of a chronic pulmonary thromboembolic disease. They conclude that ``total surgical resection with the addition of chemotherapy, radiotherapy, or both ...should offer these patients significant palliation and an opportunity for increased length of survival.'' Although, in an invited commentary, Dr Mark B. Orringer questions such a conclusion on the basis of the dismal survival of these patients, we agree with Anderson and colleagues' statement.

In the January 1994 issue of The Annals we reported on a case of primary pulmonary artery leiomyosarcoma that was treated by resection of portion of the infundibular myocardium together with the adjacent pulmonary valve leaflet and extensive endoarterectomy of the pulmonary artery bifurcation, containing a bulky polypoid neoplastic mass [2]. At the time of submission of our article the patient had been followed up for 8 months, being totally asymptomatic and relieved from the severe picture of subacute pulmonary arterial occlusive disease. We believe that additional follow-up on this case could provide useful information on this matter.

Sixteen months after her initial procedure, on routine follow-up computed tomographic scan, the patient was found to have a right adrenal mass, which was resected and identified as leiomyosarcomatous in nature. At 21 months shortness of breath, cough, and signs of right heart failure developed. Two-dimensional echocardiography showed the recurrence of an obstructing mass at the right ventricular outflow tract and pulmonary artery level. Total body computed tomographic scan suggested absence of extracardiac disease, and reoperation was advised.

At operation, a large polypoid tumor mass was found occupying the lumen of the main pulmonary artery, infiltrating its associates in advocating cell-saving processing for retransfusion of retained shed blood during cardiac operations.

References

  1. De Haan J, Boonstra PW, Monnik SHJ, Ebels T, van Oeveren W. Retransfusion of suctioned blood during cardiopulmonary bypass impairs hemostasis. Ann Thorac Surg 1995;59:901–7.[Abstract/Free Full Text]
  2. Duncan ES, Edwards WD, Dale WA. Caution regarding autotransfusion. Surgery 1974;76:1024–30.[Medline]
  3. Bartels C, Claeys L, Ktenidis K, Nigbur H, Horsch S. Intraoperative whole blood autotransfusion during venous thrombectomy. J Cardiovasc Surg 1994;35:109–14.[Medline]
  4. Ouriel K, Shortell CK, Green RM, DeWeese JA. Intraoperative autotransfusion in aortic surgery. J Vasc Surg 1993;18: 16–22.[Medline]
  5. Milne AA, Drummond GB, Paterson DA, Murphy WG, Ruckley CV. Disseminated intravascular coagulation after aortic aneurysm repair, intraoperative salvage autotransfusion, and aprotinin. Lancet 1994;344:470–1.[Medline]
  6. Kinglsey JR, Valeri CR, Peters H, et al. Citrate anticoagulation and cell washing for intraoperative autotransfusion in the baboon. Am J Surg 1976;131:717–21.[Medline]
  7. Rabiner SF, Friedman LH. The role of intravascular haemolysis and the reticulo-endothelial system in the production of a hypercoagulable state. Br J Haematol 1968;14:105–18.[Medline]




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