Symposium on cardiac tumors

Introduction The spectrum of cardiac tumors☆

Myxomas are the most common type of cardiac benign tumors and most of them are located in the left atrium, followed by the right atrium. The majority of Myxomas is located in the left atrium and has a variable clinical presentation. Myxomas affect patients within a wide age range (15–80 years), and the average age is approximately 50 years. There is a female predominance in the sporadic form. Myxomas are usually pedunculated, solitary, and sporadic but may be associated with familial autosomal dominant syndromes.

We report a 38-year-old female presented with large myxoma in the right atrium and atypical presentation and successfully underwent surgical excision of right atrial myxoma. The patient was asymptomatic on 6 months follow up.

Cardiac myxomas are the most frequent finding among primary cardiac tumors. Clinical manifestations depend on the involvement in valvular obstruction, distant arterial embolisms, or nonspecific, constitutional symptoms. Transoesophageal Echocardiography is the cornerstone for diagnosis of atrial myxoma. Cardiac myxomas should be managed with surgical resection.

Cardiac tumors are an uncommon cause for neurologic disease, but if undiagnosed can be associated with devastating neurologic consequences. Primary cardiac tumors, both benign and neoplastic, and metastatic tumors occur. Primary cardiac tumors are more likely to be associated with neurologic embolic complications. Metastatic cardiac tumors are more likely to be associated with valvular distraction, arrhythmia, diminished cardiac output and indirect neurological dysfunction. Primary and metastatic cardiac tumors may result in cerebral metastatic disease. Atrial myxoma, a benign primary cardiac tumor, is the most common cardiac tumor associated with neurologic disease, and most commonly causes cerebral embolization and stroke. The use of thrombolytic therapy for these strokes is controversial. Additionally, delayed manifestations, including aneurysm formation and intracranial hemorrhage, are possible. Aneurysm formation has been described as occurring after removal of the primary tumor. The availability of noninvasive cardiac imaging has significantly helped decrease the neurologic morbidity of cardiac tumors and has led to frequent successful intervention.

A 53-year-old woman presented to the emergency department with a 2-week history of dyspnoea and chest pain. Computed tomography pulmonary angiography was performed to exclude acute pulmonary embolism (PE). This demonstrated a large right atrial mass and no evidence of PE. Transthoracic echocardiography followed by cardiac magnetic resonance imaging confirmed a mobile right atrial mass. Surgical resection was then performed confirming a giant right atrial myxoma. We describe the typical clinical, radiologic, and pathologic features of right atrial myxoma.

We sought to compare clinical and pathologic characteristics of ventricular tumors and to detect whether differences exist in short- and long-term survival after resection.

From 1964 to 2005, 323 patients had cardiac surgery for resection of primary cardiac tumors; 53 (16%) patients had primary ventricular tumors. We randomly sampled 53 characteristics of ventricular tumors.

Patients with ventricular tumors were younger than those with atrial tumors (34.8 vs 54.6 years; P < .0001). New York Heart Association functional status was similar at presentation, although patients with atrial tumors had increased risk of atrial fibrillation (P < .05), thromboembolic events (P = .04), and mitral stenosis (P = .008) at the time of presentation. Patients with ventricular tumors had an increased incidence of myocardial invasion (14% vs 2%; P = .02) and had significantly longer cardiopulmonary bypass (80 vs 65 minutes; P < .05) and crossclamp (52 vs 39 minutes; P = .03) times. Operative mortality was 4% and 0% in the ventricular and atrial groups, respectively (P = not significant). Follow-up was obtained in 89% of patients at a mean follow-up time of 7.21 years. A Kaplan–Meier survival plot demonstrated no difference in survival characteristics of both groups. At follow-up, 81% and 74% of ventricular and atrial tumors, respectively, were minimally symptomatic (New York Heart Association class I/II; P = .13). Patients with atrial and ventricular tumors had a 6% and 0% tumor recurrence rate, respectively (P = .12).

Surgical resection for ventricular tumors is effective and results in excellent long-term outcome. Early surgical treatment should be strongly considered in patients with primary ventricular tumors.