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.

Mortalidad por mesotelioma en Argentina, 1980-2013 / Mesothelioma mortality in Argentina, 1980-2013

RESUMEN Se estimó la tasa de mortalidad por mesotelioma y su distribución sociodemográfica y temporal en Argentina para el período 1980-2013 con datos del Sistema de Estadísticas Vitales del Ministerio de Salud de la Nación. Se encontraron 3.259 defunciones por mesotelioma, lo que resulta en una tasa de mortalidad estandarizada por edad de 3,1/1.000.000 en 1980 y de 5,7/1.000.000 en 2013, con un aumento promedio del 84,1% en 34 años. El incremento de la tendencia fue más claro a partir de 1997. En todos los años, la tasa de mortalidad fue mayor en hombres que en mujeres. Los resultados sugieren antecedentes de exposición al asbesto en el pasado. Aparentemente, la exposición predominante fue la ocupacional, más común entre los hombres que concentraron los casos. Se recomiendan acciones dirigidas a hacer más efectiva la prohibición ya en vigor y la vigilancia en salud orientada a los ambientes de trabajo, trabajadores previamente expuestos y la población en general.

ABSTRACT Mesothelioma mortality and its socio-demographic and temporal patterns in Argentina from 1980 to 2013 were estimated using data from death certificates obtained from the Vital Statistics System of Argentina’s National Ministry of Health. There were 3,259 mesothelioma deaths corresponding to an age-adjusted mortality of 3.1/1,000,000 in 1980 and 5.7/1,000,000 in 2013, an average increase of 84.1% in 34 years. This raising trend became clearer after 1997. Males had higher mortality estimates compared with women in every year of the series; these findings suggest past exposure to asbestos. It is plausible that the asbestos exposure was mostly occupational, which is more common among men. Actions related to reinforcing the asbestos ban already in place and strengthening health surveillance directed at workplaces, previously exposed workers, and the population in general are recommended.

Biatrial approach provides better outcomes in the surgical treatment of cardiac myxomas

Abstract Objective: We aimed to present clinical features, surgical approaches, importance of surgical technique and long-term outcomes of our patients with cardiac myxoma who underwent surgery. Methods: We retrospectively collected data of patients with cardiac myxoma who underwent surgical resection between February 1990 and November 2014. Biatrial approach is the preferred surgical method in a large proportion of patients that are operated due to left atrial myxoma because it provides wider exposure than the uniatrial approach. To prevent recurrence during surgical resection, a large excision is made so as to include at least 5 mm of normal area from clean tissue around the tumor. Moreover, special attention is paid to the excision that is made as a whole, without digesting the fragment of tumor with gentle dissections. Results: Forty-three patients (20 males, mean age of 51.7±8.8 years) were included. Most common symptom was dyspnea (48.8%). Tumor was located in the left atrium in 37 (86%) patients. Resections were achieved via biatrial approach in 34 patients, uniatrial approach in 8 patients, and right atriotomy with right ventriculotomy in 1 patient. One patient died due to low cardiac output syndrome in the early postoperative period. Mean follow-up time was 102.3±66.5 months. Actuarial survival rates were 95%, 92% and 78% at five, 10 and 15 years, respectively. Recurrence was observed in none of the patients during follow-up. Conclusion: Although myxomas are benign tumors, due to embolic complications and obstructive signs, they should be treated surgically as soon as possible after diagnosis. To prevent recurrence, especially in cardiac myxomas which are located in left atrium, preferred biatrial approach is suggested for wide resection of the tumor and to avoid residual tumor.

Mortality and Embolic Potential of Cardiac Tumors / Mortalidade e Potencial Embólico dos Tumores Cardíacos

Background: Cardiac tumors are rare, mostly benign with high embolic potential. Objectives: To correlate the histological type of cardiac masses with their embolic potential, implantation site and long term follow up in patients undergoing surgery. Methods: Between January 1986 and December 2011, we retrospectively analyzed 185 consecutive patients who underwent excision of intracardiac mass (119 females, mean age 48±20 years). In 145 patients, the left atrium was the origin site. 72% were asymptomatic and prior embolization was often observed (19.8%). The diagnosis was established by echocardiography, magnetic resonance and histological examination. Results: Most tumors were located in the left side of the heart. Myxoma was the most common (72.6%), followed by fibromas (6.9%), thrombi (6.4%) and sarcomas (6.4%). Ranging from 0.6cm to 15cm (mean 4.6 ± 2.5cm) 37 (19.8%) patients had prior embolization, stroke 10.2%, coronary 4.8%, peripheral 4.3% 5.4% of hospital death, with a predominance of malignant tumors (40% p < 0.0001). The histological type was a predictor of mortality (rhabdomyomas and sarcomas p = 0.002) and embolic event (sarcoma, lipoma and fibroelastoma p = 0.006), but not recurrence. Tumor size, atrial fibrillation, cavity and valve impairment were not associated with the embolic event. During follow-up (mean 80±63 months), there were 2 deaths (1.1%) and two recurrences 1 and 11 years after the operation, to the same cavity. Conclusion: Most tumors were located in the left side of the heart. The histological type was predictor of death and preoperative embolic event, while the implantation site carries no relation with mortality or to embolic event. .

Fundamento: Os tumores do coração são infrequentes, em sua maioria benignos e com alto potencial embólico. Objetivo: Correlacionar o tipo histológico do tumor cardíaco com seu potencial embólico, com o sítio de implantação e analisar a evolução tardia destes pacientes submetidos à cirurgia. Métodos: No período de dezembro de 1986 a setembro de 2011 foram retrospectivamente analisados 186 pacientes operados (119 do sexo feminino e idade média de 48 ± 20 anos). Foram 145 tumores de átrio esquerdo (77%), 72% dos pacientes assintomáticos e 19,8% com embolização prévia. O diagnóstico foi confirmado por ecocardiograma, ressonância magnética e exame histológico. Resultados: A maioria dos tumores situava-se nas câmaras esquerdas. O mixoma foi o mais frequente (72,6%), seguido dos fibromas (6,9%), trombos (6,4%) e sarcomas (6,4%). Seus tamanhos variaram de 0,6cm a 15 cm (média de 4,6 ± 2,5cm). Houve 37 embolizações prévias à operação (10,2% AVC, 4,8% IAM e 4,3% periférica). Foram 5,4% de óbito hospitalar, com predomínio nos tumores malignos (40% p < 0,0001). O tipo histológico foi preditor de mortalidade (rabdomioma e sarcomas p = 0,002) e de evento embólico (sarcomas, fibroelastoma e lipoma p = 0,006), porém não de recidiva. O tamanho tumoral, a fibrilação atrial, a cavidade e valva acometida não apresentaram relação com o evento embólico. Durante o seguimento (média de 80 ± 63 meses), houve 2 óbitos (1,1%) e duas recidivas tumorais 1 e 11 anos após a operação, ambas para a mesma cavidade. Conclusão: O tipo histológico foi preditor de óbito e de evento embólico pré-operatório, enquanto o sítio de implantação não. .

Clinical Implication of Surgical Resection for the Rare Cardiac Tumors Involving Heart and Great Vessels

This study aimed to investigate the clinical implication of surgical resection for the malignancies of heart and great vessels. Between January 2001 and May 2011, a retrospective review of the results in 12 patients was conducted. There were 6 patients with primary cardiac tumor including leiomyosarcoma, angiosarcoma, undifferentiated type sarcoma and malignant fibrous histiocytoma. The remaining 6 patients had the metastatic tumors or adjacent invasion to the heart and great vessels. Six of seven patients who underwent complete resection had no evidence of recurrence. However, four of five patients who underwent incomplete resection or biopsy showed local recurrence or distant metastasis of residual tumor, and one of them required reoperation for recurred tumor. In-hospital mortality was 8.3% and the mean survival of all patients was 22.2 +/- 6.1 months. Survival of the incomplete resection group, except for the two biopsy cases, was 25.9 +/- 7.9 months, and there was no mortality in the complete resection group. Therefore, clinical outcomes in patients who had malignancies of the heart and great vessels may be improved when the aggressive and complete resection, or possible debulking for palliation, was performed. Moreover, adjuvant multimodality therapy may be imperative to prevent recurrence or metastasis, and to provide improved survival.

Angiosarcoma intracardíaco: presentación de un caso / Intracardiac sarcoma: a case report

Objetivo: Revisión y presentación de un caso de angiosarcoma cardíaco. Introducción: Los tumores malignos cardíacos primarios aparecen con una frecuencia de 0,0017-0,33 por ciento (sarcoma 16 por ciento y angiosarcoma 26 por ciento); predominan los metastáticos. Alta malignidad; relación hombres-mujeres, 2:1; edad, entre los 20 y los 60 años. La clínica depende de la localización, el tamaño y la histología. Predominan en la aurícula derecha. Trombogénicos; destruyen la estructura; producen derrame, isquemia; arritmias; muerte súbita. Invaden contiguamente; metastatizan a distancia. Escasa respuesta a radioterapia y quimioterapia. Pronóstico ominoso. Presentación del caso: Mujer de 72 años; antecedente de disnea CF II, 2 síncopes. Masa en la aurícula derecha, heterogénea, sin pedículo y otra en el ventrículo derecho, infiltración pericárdica. Pericardiocentesis diagnóstica y terapéutica. Estudios negativos de lesión extracardíaca. ASA IV. Estimación del riesgo perioperatorio: bloqueo A-V, SIRS, embolizaciones. Anestesia general balanceada, infusión de ípsilon y solución GIK. Derivación cardiopulmonar (CPB) 71' y clampeo aórtico 49'. Cirugía: resección de masa en la aurícula, el pericardio y la pleura adyacente. Destete de CPB con marca paso transitorio, apoyo inotrópico. Postoperatorio: hipoperfusión tisular, acidemia, hiperglucemia, hipopotasemia, sin respuesta terapéutica. Óbito a las 4 horas, con diagnóstico presuntivo de respuesta inflamatoria sistémica.

Objective: Review and presentation of a case of cardiac angiosarcoma. Introduction: Primary cardiac malignant tumors have frequency between 0,0017-0,33 per cent (sarcoma 16 per cent and angiosarcoma 26 per cent), predominantly metastatic. High malignancy; male-female ratio: 2:1; appears between ages 20 to 60. Symptoms depend on location, size and histology. Predominate in right atrium. Thrombogenic, they destroy the structure; cause spills, ischemia, arrhythmia, sudden death. Invade contiguously; metastasize at a distance. Poor response to radiotherapy and chemotherapy. Ominous prognosis. Case report: 72 year old female. Dyspnoea CF II, two syncopes. Heterogeneous mass in right atrium (RA) and another one in right ventricle with pericardial infiltration. Diagnosis and treatment by puncture of the pericardium. Studies negative for primary extracardiac injury. ASA IV. Perioperative risk estimation: AV Block, SIRS, embolizations. Balanced general anesthesia, infusion of GIK solution and Ipsilon. Cardiopulmonary by-pass 71' and cross aortic clamp 49'. Surgery: resection mass in RA and adjacent pericardium and pleura. Weaning from CPB: transitory pacemaker and inotropic support. Surgery: resection mass in RA and adjacent pericardium and pleura. Postoperative period: tissue hypoperfusion, lactacidemia, hyperglycemia resistant to insulin, hypopotassemia. No response to treatment. Cardiac arrest at the 4th hour with a presumptive diagnosis of systemic inflammatory response. Death.

Objetivo: Revisao e apresentaçao de um caso de angiosarcoma cardíaco. Introduçao: A ocorrência de tumores cardíacos malignos primários está na faixa de 0,0017-0,33 por cento (sarcoma 16 por cento e angiosarcoma 26 por cento); predominam os metastáticos. Alta malignidade; relaçao homens-mulheres, 2:1; faixa etária: 20 a 60 anos. A clínica depende da localizaçao, do tamanho e da histologia. Predominam na aurícula direita. Trombogénicos; destroem a estrutura; causam derrame, isquemia; arritmias; morte súbita. Invadem estruturas vizinhas; produzem metástase a distancia. Fraca resposta a radioterapia e quimioterapia. Prognóstico nefasto.Apresentaçao do caso: Mulher de 72 anos; antecedente de dispnéia CF 11,2 síncopes. Massa na aurícula direita, heterogênea, sem pedículo e outra no ventrículo direito, infiltraçao pericárdica. Pericardiocentese diagnóstica e terapêutica. Estudos negativos de lesao extracardíaca. ASA IV. Estimaçao do risco perioperatório: bloqueio A-V, SIRS, embolizaçoês. Anestesia geral balanceada, infusao de Ipsílon e soluçao GIK. By-pass cardiopulmonar (CPB) 71' e clampeamento da aorta 49'. Cirurgia: ressecçao de massa na aurícula, no pericárdio e na pleura adjacente. Retiro gradual do CPB com marca-passo transitório, apoio inotrópico. Pósoperatório: hipoperfusao tissular, acidemia, hiperglicemia, hipopotassemia, sem resposta terapêutica. Óbito 4 horas depois, com diagnóstico presuntivo de resposta inflamatória sistêmica.

Surgical experience with cardiac myxomas

Cardiac myxomas are the most common benign intracardiac tumours. We studied the clinical presentation of cardiac myxomas and the morbidity, mortality and recurrence rate following surgery at our institution over a 6 year period. This historical longitudinal study was performed at department of Cardiac Surgery, Armed forces Institute of Cardiology and National Institute of Heart Diseases Rawalpindi, Pakistan between January 2002 and March 2008 a total number of 8506 cardiac operations were performed. Of these 34 patients [19 males, 15 females] underwent complete excision of primary or recurrent intracardiac myxomas. Pre-operative diagnosis was established by echocardiography. All patients underwent operation soon after the diagnosis of a myxoma was made. Complete tumour excision followed by close inspection and copious saline irrigation of the cardiac chambers was done in each case. Of the 32 patients who survived the surgery, 29 patients were followed up at regular intervals for recurrence. The mean follow-up period was 34 months. Cardiac myxomas constituted 0.40% of the total cardiac operations at our institution. They most commonly occurred in the fourth decade. The commonest location was the left atrium [LA] [79%] followed by the right atrium [RA] [14%]. Only one patient had myxoma in the right ventricle [RV]. Patients with LA myxoma simulated mitral stenosis clinically whereas patients with RA and RV myxomas presented with features of right heart failure. A smaller percentage presented with embolic and constitutional symptoms. There were two early deaths. One recurrence was noted at 27 months after surgery. No late deaths were observed in the study. Cardiac myxomas form a very small percentage of the cardiac cases. A high index of suspicion is essential for diagnosis. Echocardiography is the ideal diagnostic tool as also for follow-up. Immediate surgical treatment is indicated in all patients. Cardiac myxomas can be excised with a low rate of mortality and morbidity

Lipoma of heart: A rare neoplasm seen on autopsy.

The most frequent primary tumour of the heart is myxoma, followed by lipoma, rhabdomyoma, haemangioma and lymphangioma. Primary tumors of the heart constitute 0.4% of autopsy specimens. We report a case of 40 years male who died suddenly and his heart was received in Pathology Department for examination. In the left ventricular wall, a well circumscribed yellowish mass was seen which on microscopy proved to be a lipoma.

CT scan in evaluation of cardiac masses

To evaluate the usefulness of CT scan in Cardiac tumor A descriptive study with convenient sampling. We studied seven cases referred to us for work up of cardiac masses, the contrast enhanced CT scan was able to identify and give the extent in five of these patients. Two patients were negative on CT scan but were confirmed to have a mass in the cardiac chamber by echocardiography. While CT was able to identify the thrombotic mass extending into the heart in two of the patients which remained inconclusive on echocardiography. CT is better modality for the extent of the lesion and echocardiography is better as an initial modality to screen the cardiac chambers

Treatment of primary cardiac malignancies with orthotopic heart transplantation

OBJECTIVE: Heart transplantation has become available as a possible treatment for patients with malignancies. Primary cardiac malignant tumors are extremely rare but several patients have been treated with this modality. Whether survival is improved over the direct removal of tumor or heart transplantation is not known. We compiled data regarding malignant primary heart tumors that have been treated at various transplant centers in order to determine if early diagnosis and treatment with cardiac transplantation has resulted in an improved mortality. METHODS: A total of 173 questionnaires were sent to the heart transplant centers across the United States and Canada inquiring about those patients who were found to have a primary cardiac malignant tumor and who underwent heart transplantation. Cases reported in the literature, which had undergone transplantation, were also reviewed by a search in MEDLINE. RESULTS: Twenty-four cases were collected. The overall survival time was from 1 month to 66 months. The actuarial survival was 54% at 12 months, 45% at 24 months and 35% at 36, 48 and 60 months respectively. Metastases were present in 10 out of the 14 deceased patients, possibly being one of the major factors affecting survival. Only 1 living patient developed metastases. CONCLUSION: Survival rates of patients with primary cardiac malignancies treated with resection, radiation, chemotherapy, or a combination of them (conventional therapy) versus heart transplantation are similar. Early diagnosis and resection are the most important factors for a better outcome, however these factors will not guarantee success since the presence or development of metastasis is a major contributor to death in both groups of patients