title: A case report of primary cardiac myxofibrosarcoma presenting with severe congestive heart failure.
abstract: BACKGROUND
  Primary cardiac sarcomas are extremely rare. Furthermore, the myxofibrosarcomas are one of the rarest forms of cardiac sarcomas, and its prognosis is known to be quite poor.
  
  
  METHODS
  This is a case of a 23-year-old man who presented with acute severe congestive heart failure caused by almost complete obstruction of the mitral valve due to a large left atrial tumor. The patient required endotracheal intubation before his arrival to the hospital, and underwent an emergent surgical excision of the tumor. The tumor had a complex shape and originated from the orifice of the right upper pulmonary vein. Because the tumor seemed to extend over most of the surface of the left atrium, it seemed impossible to reconstruct the left atrium had we done a complete transmural resection. Instead, we carefully peeled the tumor leaving the outer layer of the left atrial wall. We applied cryoablation to the attached site, in order to prevent a recurrence of the tumor. The pathology report revealed that the tumor was a myxofibrosarcoma, and it seemed to originate from the heart. The patient received radiation therapy after the surgery and continues to be alive and well after 1-year, without apparent recurrence.
  
  
  CONCLUSIONS
  Cardiac myxofibrosarcoma can cause acute, severe left-sided heart failure. Non-transmural atrial wall resection with cryoablation might be effective for patients with cardiac myxofibrosarcomas with extensive atrial attachment.
authors.affiliation: Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-12 Maeda Teine-ku, Sapporo, 006-0811, Japan. white_shepherds_khno@hotmail.com.
authors.forename: Kosuke
authors.identifier: http://orcid.org/0000-0002-5083-085X
authors.initials: K
authors.lastname: Ujihira
authors.affiliation: Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-12 Maeda Teine-ku, Sapporo, 006-0811, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Yamada
authors.affiliation: Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-12 Maeda Teine-ku, Sapporo, 006-0811, Japan.
authors.forename: Naritomo
authors.initials: N
authors.lastname: Nishioka
authors.affiliation: Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-12 Maeda Teine-ku, Sapporo, 006-0811, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Iba
authors.affiliation: Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-12 Maeda Teine-ku, Sapporo, 006-0811, Japan.
authors.forename: Ryushi
authors.initials: R
authors.lastname: Maruyama
authors.affiliation: Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-12 Maeda Teine-ku, Sapporo, 006-0811, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Nakanishi
authors.affiliation: Department of Surgical Pathology, Hokkaido University Hospital, N14W5 Kita-ku, Sapporo, 060-8648, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Shimizu
authors.affiliation: Department of Surgical Pathology, Hokkaido University Hospital, N14W5 Kita-ku, Sapporo, 060-8648, Japan.
authors.forename: Kanako C
authors.initials: KC
authors.lastname: Hatanaka
authors.affiliation: Department of Surgical Pathology, Hokkaido University Hospital, N14W5 Kita-ku, Sapporo, 060-8648, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Mitsuhashi
authors.affiliation: Department of Pathology, Teine Keijinkai Hospital, 1-12 Maeda Teine-ku, Sapporo, 006-0811, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Shinohara
authors.affiliation: Department of Pathology and Biobank, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, 565-8565, Japan.
authors.forename: Hatsue Ishibashi
authors.initials: HI
authors.lastname: Ueda
mesh_terms: D005354:Fibrosarcoma / Q000150:complications* / Q000601:surgery; D006325:Heart Atria; D006333:Heart Failure / Q000209:etiology*; D006338:Heart Neoplasms / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D055815:Young Adult
keywords: Cardiac tumor; Cryoablation; Heart failure; Myxofibrosarcoma