Post written by Rafael Romero-Castro, MD, PhD, from the Hospital Universitario Virgen Macarena, Seville, Spain.

We report EUS-FNA in 2 patients with right atrial masses, 1 of them requiring 3 passes to obtain diagnostic cytologic material.

I think these 2 cases deserve to be known by the community of endosonographers because of 2 main reasons. First, although cardiac tumors are not frequent, in these 2 patients the diagnoses were obtained in a safe, fast, and accurate way having a decisive impact in the clinical decision-making algorithm, avoiding more invasive procedures. Second, these 2 cases, especially the second 1 in which 3 passes had to be performed transversing the left atrium to reach the right atrium, show the safety and accuracy of the EUS-guided interventions on the vascular system, even in this scenario of a contractile and moving vascular organ such as the heart.

The take-home message would be after careful selection of the cases and taking all the precautions to avoid hemorrhage and infection as provided in the video, EUS-guided interventions on the heart could be taken into consideration in the management of patients with cardiac lesions to avoid more invasive procedures.

The experience on EUS-guided angiotherapy is increasingly expanding, probing  is a safe and accurate way to treat a wide array of dire clinical situations, especially bleeding  gastric varices, measure of portal vein pressure, and performance of EUS-FNA for remote intravascular thrombuses. All of these procedures provide a substantial clinical benefit for the patients.

I hope the future of EUS-guided interventions on the vascular system will allow us to give another turn on the screw in the management of cancer and treat lesions beyond the gastrointestinal tract by injecting chemotherapeutic agents. Our experience with the EUS-guided cardiac interventions would be another step into this new enthralling frontier of the vascular system.

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