A rare case of giant cardiac malignant tumor with positive panel reactive antibody

PURPOSE: A 31-year-old female patient presented with a giant primary cardiac malignancy occupying the right atrium and invading the tricuspid valve and right ventricle. METHODS: Due to the inoperability of the tumor by conventional surgery, heart transplantation was considered. However, the patient had a strongly positive panel reactive antibody (PRA), indicating a high risk of rejection. Our team performed an emergency heart transplantation and administered a combination of immunosuppressive therapies postoperatively. RESULT: One month after the transplantation, the patient recovered smoothly and was discharged from the hospital. CONCLUSION: Despite giant cardiac sarcoma and high PRA-mediated rejection risk, tailored perioperative strategies, including aggressive desensitization, multimodal immunosuppression, and close surveillance, enabled successful transplantation and recovery. This highlights the feasibility of heart transplantation in select sarcoma cases with meticulous rejection management.