Cardiac Tumors

• • Most common cardiac neoplasm is a metastatic lesion (carcinoma of lung or breast, sarcoma, melanoma)

  • 75% of primary cardiac neoplasms are benign (myxoma, rhabdomyoma)

Myxoma

• • 75% of benign primary cardiac tumors

  • Appearance ranges from smooth, round, firm encapsulated mass to loose conglomeration of gelatinous material

  • Most attached to fossa ovalis of left atrial septum; some may occur in right atrium or ventricles

  • Histologically, contains various mesenchymal cells

  • -Abnormal DNA ploidy may correlate with recurrence

  • Papillary fronds attached to aortic valve associated with cerebral and coronary embolization

  • Fibromas occur in pediatric patients, slowly invading conduction system

  • -Can cause sudden death from arrhythmias

Epidemiology

• • Primary tumors of heart are rare

  • -0.002-0.3% of autopsies

  • Occur in any age

Symptoms and Signs

• • Presentation depends on type and location of tumor

  • Malignant tumors: Rapidly progressive congestive heart failure from valvular or myocardial infiltration

  • Myxoma: Fever, weight loss, anemia, systemic embolization

  • Mitral stenosis can occur from tumor causing characteristic early diastolic sound "tumor plop"

  • Fibromas can cause sudden death from arrhythmias

Laboratory Findings

• • Myxoma: Abnormal ESR, gamma globulin, liver aminotransferases

  • Anemia, thrombocytopenia common in many tumors

  • Transesophageal echocardiography: Procedure of choice

  • MRI and CT may be helpful in infiltrative lesions

• • Evaluate for other sites of tumor

• • Physical exam

  • Echocardiography, possibly transesophageal

  • MRI for invasive lesions

• • Most benign lesions: Resectable/curable

  • Myxomas

  • -Cardiopulmonary bypass required

    -Resect tumor and rim of normal tissue around attachment stalk

  • Surgery for cardiac sarcomas and metastatic lesions is usually for diagnosis; occasionally palliative

  • Orthotopic heart transplantation (rarely)

Surgery

Indications

• • Suspected myxoma, consider repair

Complications

• • Embolization during tumor manipulation

Prognosis

• • Operative mortality < 1%

  • Long-term survival for malignant cardiac lesions remains poor

Prevention

• • Resect rim of normal tissue around attachment stalk to prevent recurrence of myxomas

References