Circumferential Resection of the Right Atrium to Excise Angiosarcoma

BACKGROUND: Cardiac angiosarcomas are rare, with no established treatment guidelines. There is limited reporting of large cardiac angiosarcomas requiring extensive atrial resection and reconstruction, and limited data on outcomes after resection with positive margins. CASE SUMMARY: A 51-year-old man with multiple comorbidities was diagnosed with nonmetastatic 7.1 × 5.6 × 4.9 cm primary cardiac angiosarcoma in the right atrium extending into the superior vena cava. The mass was circumferentially resected with reconstruction of the right atrium using bovine pericardial patch. Histopathology confirmed a grade II spindle cell variant angiosarcoma with positive margins. Subsequent management included chemotherapy, targeted therapy, and radiotherapy for metastatic disease. He has had continued survival at 28 months postoperatively. DISCUSSION: Cardiac angiosarcomas can be large and challenging to resect. Aggressive surgical resection may prolong survival, even with positive margins. TAKE-HOME MESSAGE: Extensive surgical resection may improve survival for cardiac angiosarcoma with locally extensive and metastatic disease.