Outcomes after surgical resection of primary non-myxoma cardiac tumors

Abstract Objective: Primary cardiac tumors are rare lesions with different histological type. We reviewed our 17 years of experience in the surgical treatment and clinical results of primary non-myxoma cardiac tumors. Methods: Between July 2000 and February 2017, 21 patients with primary cardiac tumor were surgically treated in our institution. The tumors were categorized as benign non-myxomas and malignants. Data including the demographic characteristics, details of the tumor histology and grading, cardiac medical and surgical history, surgical procedure of the patients were obtained from the hospital database. Results: Eleven patients were diagnosed with benign non-myxoma tumor (male/female:7/4), ranging in age from 10 days to 74 years (mean age 30.9±26.5 years). Papillary fibroelastoma was the most frequent type (63.6%). There were two early deaths in benign group (all were rhabdomyoma), and mortality rate was 18%. The mean follow-up period was 69.3±58.7 months (range, 3 to 178 months). All survivals in benign group were free of tumor-related symptoms and tumor relapses. Ten patients were diagnosed with malignant tumor (sarcoma/lymphoma:8/2, male/female:3/7), ranging in age from 14 years to 73 years (mean age 44.7±18.9 years). Total resection could be done in only three (30%) patients. The mean follow-up period was 18.7±24.8 months (range, 0-78 months). Six patients died in the first 10 months. Conclusion: Complete resection of the cardiac tumors, whenever possible, is the main goal of surgery. Surgical resection of benign cardiac tumors is safe, usually curative and provides excellent long-term prognosis. On the contrary, malignant cardiac tumors still remain highly lethal.

Surgical intervention for cardiac neuplasm in fetus / 中华胸心血管外科杂志

Objective To summarize the clinical experience of surgical intervention for cardiac neoplasm in a fetus . Methods A 32-year-old pregnant woman was admitted to our hospital for complaint of fetal cardiac neoplasm .A separated het-erogenic cardiac occupying lesion was identigied at right atrium of the fetus by echocardiography , whose size is 2.85 cm ×2.25 cm, but the pathogenic origin still remained uncertain, maybe originate from ether pericardium or atrium.The annulus of tri-cuspid valve was compressed nearly 50% with the presence of amount of pericardial effusion.The fetal heart rate decreased at some fetal position resulting in the compression to the heart.So an Ex-utero Intrapartum Therapy(EXIT) procedure was per-formed under the supply of placenta at the 32 weeks of pregnancy.Cesarean section was performed with intact umbilicus and fe-tal circulation by obstetricians.Consequently, the median sternotomy of this fetus and pericardiotomy were performed , with 30 ml clear pericardial effusion drained .The tumor was confirmed to be giant right atrial neoplasm after the intraoperative explora-tion.Considering on the high risk of the cardiopulmonary bypass and limited time for EXIT , the giant atrial neoplasm was left alone with delayed sternum closure after the effectively decompression of the heart .The omphalotomy was successfully per-formed after the EXIT surgery.The neoplasm resection and the repair for its defect on right atrium were performed with cardiop-ulmonary bypass 2 days later.Results Convalesce of this mother was quite good after cesarean resetion .Hemodynamics of the premature baby was satisfatory after the resection of right atrial neoplasm which pathological report was benign hemangioma . Conclusion Via multiple disciplines collaboration , EXIT intervention for fetus is feasible and safe under adequate prepara-tion.

Successful Surgical Treatment of a Right Atrial Myxoma Complicated by Pulmonary Embolism

A 76-year-old woman with hypertension was admitted to the hospital with complaints of chest pain and dyspnea. An echocardiogram and pulmonary computed tomography angiography showed right atrial myxoma complicated with pulmonary thromboembolism. An operation to resect the right atrial myxoma and pulmonary embolism was recommended; however, the patient refused and was discharged with anticoagulation therapy. Two years later, she developed dyspnea. Radiological studies and echocardiography showed similar results with the previous findings. The patient underwent mediastinotomy with resection of the right atrial myxoma and pulmonary embolectomy. As there are few reports on right atrial myxoma complicated with pulmonary embolism, we report a successful case of surgical removal of right atrial myxoma and pulmonary embolism.

Multimodality Imaging Can Help to Doubt, Diagnose and Follow-Up Cardiac Mass

Primary cardiac lymphoma is a very rare form of lymphoma primarily or mainly involving the heart, as in the two cases presented in this report. Various imaging modalities, including coronary computed tomography angiography, cardiac magnetic resonance imaging and positron emission tomography were useful for the characterization and diagnosis of cardiac mass. Pathologic confirmation was successful with endomyocardial biopsy under echocardiographic guidance, intra- and extracardiacally. In primary cardiac lymphoma, diagnosis using multiple modalities may be useful for mass characterization, and for response monitoring after chemotherapy.

A Case of Exceptionally Rapid Growing Cardiac Myxoma / 영남의대학술지

Myxoma is the most common type of primary cardiac tumor and about 75% of myxomas occur in the left atrium of the heart. Most myxomas are diagnosed by echocardiography. The growth rate of myxoma is clearly unknown and newly developed myxoma is difficult to understand clearly the onset of growth. We describe the case of a newly developed huge left atrial myxoma (7x7 cm)which showed no echocardiographic evidence of the tumor four years ago. Four years later the patient underwent transthoracic echocardiography due to preoperative evaluation that was normal. Nine months later, she presented with dyspnea. Transthoracic echocardiography showed a large mass located in left atrium. Pathology showed a myxoma that measured 7x7 cm implying a growth rate of 0.15x0.15 cm/month.

Left Ventricular Outflow Obstruction due to a Left Ventricular Myxoma / 대한흉부외과학회지

Once it is diagnosed, immediate surgical extirpation is desirable for treating left ventricle myxoma that's accompanied with stenosis of the left ventricle outflow tract. This is because this condition may potentially induce fatal complications such as cerebral infarction or myocardial infarction that's triggered by myxoma embolus, or even sudden death due to coronary malperfusion. An 18-year-old male with the chief complaint of NYHA class II exertional dyspnea was found to have a 4x3 cm(2) sized mass on transthoracic ultrasonography, which was shown to move down the left ventricle outflow tract on the systolic phase. The mass was immediately extirpated by incision of the left ventricle; the mass was finally diagnosed as a myxoma. The patient was discharged on at the 10th day postoperatively without any complications. On the 22-month follow-up observation made at the out-patient clinic after discharge, there have been no noticeable, significant changes seen on physical examination or the cardiac ultrasonography.

A case of cardiac malignant fibrous histiocytoma treated by cardiac autotransplantation / 대한내과학회지

Primary cardiac tumors are rare findings and they are mostly benign. Malignant primary cardiac tumors make up 25% of the primary cardiac tumors and most of them are sarcomas. Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in late adulthood, and it is an extremely rare sub-type of cardiac sarcoma. It is known that MFH displays a poor clinical course with complete resection being the most important prognostic factor for survival. We described here the case of a malignant fibrous histiocytoma of the heart in a 54-year-old woman who presented with dyspnea. The tumor was treated by mass excision via cardiac explantation and autotransplantation followed by adjuvant chemotherapy. This is the first report of cardiac autotransplantation in Korea.

Primary Cardiac Sarcoma in Pregnancy: A Case Report

Primary cardiac sarcoma is a rare disease in adults. It is also associated with poor prognoses, due to diagnostic delay, therapeutic difficulty, and high metastatic potential. The coincidence of pregnancy and a primary cardiac intimal sarcoma is extremely rare. We report a pregnant woman at 27(+5) weeks gestation who was admitted to the hospital with acute-onset dyspnea. A mass was found on the left atrium by transthoracic echocardiography. Subsequently, the intracardiac mass was removed, and mitral valve replacement and modified DeVega tricuspid annuloplasty were performed. The patient was diagnosed with a undifferentiated sarcoma, and gave birth to a 1,230 g living baby boy by Caesarean section from preterm contraction at 29(+5) weeks gestation. The patient then received systemic chemotherapy. However, 10 months after the initial clinical onset, the patient suddenly died. Surgery is the standard treatment for cardiac tumors, and their removal should always be attempted, even in pregnant women. Although the overall survival rates of the patients are rather poor, palliative cardiac surgery allows the prolonging of pregnancy, until an acceptable fetal viability level is reached.

A Case of Primary Malignant Mesenchymoma of the Heart

A malignant mesenchymoma is a rare soft tissue neoplasm that show at least two types of malignant mesenchymal differentiation, in addition to poorly differentiated fibrosarcomatous elements. They grow rapidly, recur frequently, and can be found in a wide variety of location, with most occurring in the extremities. A primary malignant mesenchymoma of the heart is extremely rare, with only 20 cases having been reported worldwide in the English literature up to 2002. We experienced a case of primary cardiac malignant mesenchymoma in a 59 year old female patient, who was admitted due to exertional dyspnea. This case is reported, with a review of the relevant literature.

Cardiac Malignant Mesenchymoma: Two Cases Report / 대한흉부외과학회지

Primary cardiac tumors are rare and about 20~25% of primary cardiac tumors are malignant. Moreover, primary malignant mesenchymoma of the heart is extremely rare. Recently, we have experienced two cases of cardiac malignant mesenchymoma. In the first case, malignant mesenchymoma which was originated from the posterior wall of the left atrium obstructing the mitral orifice was revealed pathologically in a 61-year-old woman with mitral regurgitation. The mass, which was 2.7 X 3.7cm in size on the posterior wall of left atrium, was extended to the posteromedial commissure and annulus of the mitral valve. The mass was resected partially without excision of the left atrial free wall. She was discharged after 30 days without any problems and she received chemotherapy and followed up for 19months. The second case was a 4 X 5cm in size, friable, yellow-whitish multilobulated mass in the left atrium which was originated from the left lower pulmonary vein. Multiple minor tumor nodules were found in the wall of the left atrium and the posterior leaflet of mitral valve. Partial mass excision and mitral valve replacement were performed.

Left Ventricular Rhabdomyoma with Tuberous Sclerosis: A Report of one case / 대한흉부외과학회지

The most common primary heart tumor in infants is the rhabdomyoma.It is known that tuberous sclerosis is found in half of the patients with cardiac rhabdomyoma. Because the prognosis of this tumor associated with subaortic stenosis is poor,the surgical intervention is indicated.We report one case of left ventricular rhabdomyoma with tuberous sclerosis.

Capillary Hemangioma of the Right Ventricle: A Case Report / 대한흉부외과학회지

Cardiac capillary hemangioma is an extremely rare benign tumor. We report a case of 13 year old male patient who was admitted for dyspnea. After we confirmed the right ventricular mass with moderate flow obstruction by echocardiogram, we performed complete resection of the mass through the right atrium and identified the capillary hemangioma with pathologic examination. Therefore, we report the case with literature review.

Primary Left Atrial Myxosarcoma: One case Report / 대한흉부외과학회지

Primary cardiac myxosarcoma is extremely rare, which is uncommon in primary cardiac tumors. We report a primary cardiac myxosarcoma in a 40-year-old female patient who was admitted to the hospital because of exertional dyspnea and palpitation. The patient underwent emergency operation immediately after the intracardiac (left atrium) tumor was discovered by an echocardiography. Palliative tumor removal was done and final pathologic diagnosis was primary cardiac myxosarcoma. She was discharged without complications.

Surgical Intervention of Undifferentiated Cardiac Sarcoma with Metastases / 대한흉부외과학회지

We report a case of primary undifferentiated cardiac sarcoma. The tumor originated from the left atrial free wall with multi-organ metastases, e.g., lung, and adrenal gland. The patient gradually grew worse with dyspnea and hemoptysis because of the obstructed left atrial outflow. Surgical resection of the left atrial sarcoma was undertaken to save the patient's life, followed by chemotherapy and brain irradiation as adjuvant therapy. The prognosis of cardiac sarcoma with metastases is very poor. However, in patients with hemodynamic instability, surgical intervention could be a therapeutic modality as palliation.

A Case of Cardiac Lymphoma Developed in Right Atrium / 대한흉부외과학회지

Primary cardiac lymphoma is an uncommon malignancy, accounting for 1.3% of primary cardiac tumors and 0.5% of extranodal lymphomas. However, secondary involvement of the heart is seen in 8.7-27.2% of the documented clinical cases of lymphoma. A 66-year-old man was referred to us for evaluation of dyspnea. A tumor mass was detected by transthoracic and transesophageal echocardiogram in the right atrium. The tumor was surgically resected. The pathologic diagnosis was a malignant lymphoma(diffuse large B cell type) had associated with intracavitary involvement of the right atrium. But acute mediastinitis was developed and then the patient was expired due to sepsis and bleeding at postoperative 9 days.

Cardiac Metastasis of Malignant Melanoma: A Case Report / 대한흉부외과학회지

We report a case of a resection of very large intracavitary metastatic malanoma causing obstruction of the right ventricular inflow and outflow tract of the heart. A 49-year-old woman with dyspnea and generalized edema was seen. Echocardiography reveal an intra cavitary mass occupying the entire right ventricle and pericardial effusion. The lesion was palliatively resected using a cardiopulmonary bypass and was confirmed as a malignant melanoma. The patient is alive and improved symptomatically 30days after the operation.

Primary Intracardiac Hemangioma: 1 case / 대한흉부외과학회지

Intracardiac hemangiomas are very rare primary cardiac tumor and there have been at least 37 reports of surgically resected cardiac hemangiomas. Most cardiac hemangiomas are asymptomatic. In symptomatic patients, symptoms are related to the location of tumor and outflow tract obstruction or obstruction of inferior and/or superior vena cava. Sudden death may occur due to conduction disturbances. The principle of treatment is surgical resection, and the prognosis is dependent upon the size, location and multiplicity of the tumor. A 40 year old man was admitted due to chest contusion and was found to have an intracardiac mass during echocardiographic examination. The mass was successfully removed and pathologic examination showed benign hemangioma. The patient was recovered uneventfully in postoperative period and was followed up for 1 year without evidence of recurrence.

Biatrial Myxoma: A Case Report / 대한흉부외과학회지

Biatrial myxomas are extremely rare, and only two cases have been reported in Korea so far. We report a 60-year-old male patient with decreased mentality due to embolization from myxoma. In this case, two pedicles grew into both atrial chamber separately from the different origins at the atrial septum. The patient underwent emergency operation immediately after the diagnosis by an echocardiography.

Surgical Treatment of Primary Cardiac Tumor: Report of 27 cases / 대한흉부외과학회지

MATERIALS AND METHODS: Between 1979 and 1996, 27 patients with primary cardiac tumor underwent surgery at Catholic University Medical College. Mean age of patient was 45.1+/-3.03 ranging from 21 to 67 years old. Twenty-four cases were myxomas, 2 cases were chondrosarcoma, and remained case was angiosarcoma. Diagnosis was confirmed by echocardiography, cardiac angiography, CT scan, and MRI. The most common site of tumor origin was fossa ovalis limbus area (17cases:63%). A biatrial operative approach was commonly used in 15 cases and the tumor was removed through left atriotomy site. Complete excision of the tumor with a cuff of normal tissue was performed. All heart chambers were carefully explored for evidence of multicentric myxomas or other tumor debris. Most of the patients were improved on postoperative period compared to preoperative NYHA functional class. RESULTS: There was one operative death due to low cardiac output syndrome. Follow up period was 3 months to 17 years. There was 2 late deaths due to local recurrences. CONCLUSION: complete surgical excion is important for increasing cure rate. Malignancy cannot be ruled out even though preoperative echocardiography suggests benign nature. Chest CT or MRI is effective for further evalution in addition to echocardiography. In suspicious of malignancy, more extensive resection is essential and postoperative chemotheraphy or radiotherapy is useful.

Primary Undifferentiated Sarcoma of Left Atrium / 대한흉부외과학회지

Primar99y cardiac tumors are rare and about 25% of primary cardiac tumors are malignant. A primary undifferentiated cardiac sarcoma, which very rare, is presented as follows: A 28-year old woman at the 32th week of pregnancy was admitted to the hospital because of dyspnea. A large intracardiac (left atrium) tumor was found with cardiac echocardiography and MRI. Emergency operation was performed under the diagnosis of left atrial myxoma. After Cesarean section, LA-tomy was done under the cardiopulmonary bypass. Tumor removal including endocardium of left atrium was done and final pathologic diagnosis was primary undifferentiated laft atrial sarcoma. After adjuvant radiotherapy, she has been followed up in out patient bases without problems up to now.