TY  - CHAP
M1  - Book, Section
TI  - Primary Cardiac Tumors
A1  - Bethea, Brian T.
A1  - Richter, Adam
A2  - Yuh, David D.
A2  - Vricella, Luca A.
A2  - Yang, Stephen C.
A2  - Doty, John R.
PY  - 2014
T2  - Johns Hopkins Textbook of Cardiothoracic Surgery
AB  - EpidemiologyPrimary  cardiac  tumors  are  rare  with  an  overall  incidence  of  0.02  percent.  Malignant  tumors  metastatic  to  the  heart  are  much  more  common  with  an  incidence  of  1.23  percent.  About  25  percent  of  primary  cardiac  tumors  are  malignant  (made  up  mainly  of  sarcomas),  and  about  75  percent  are  benign.  Myxomas  make  up  about  50  percent  of  benign  cardiac  tumors.PathophysiologyCardiac  tumors  arise  from  various  cells  in  the  heart.  Clinical  effects  of  these  tumors  are  based  chiefly  on  the  size  and  location  of  the  mass.  Tumors  can  cause  obstruction  of  valvular  orifices  as  well  as  incompetence  of  valve  leaflets,  leading  to  symptoms  of  obstruction  and  congestive  heart  failure.  In  addition,  friable  tumors  can  embolize,  causing  systemic  effects.Clinical  featuresThe  most  common  presentation  of  cardiac  tumors  is  evidence  of  congestive  heart  failure  due  to  obstruction  and/or  valvular  insufficiency.  Signs  and  symptoms  of  embolization  include  myocardial  infarction,  stroke,  peripheral  malperfusion,  and  mesenteric  ischemia.  Constitutional  symptoms  such  as  malaise,  weight  loss,  myalgias,  and  fevers  can  occur  due  to  elaboration  of  cytokines.  Other  presenting  signs  and  symptoms  can  include  arrhythmias,  sudden  death,  chest  pain,  and  pericardial  tamponade.DiagnosisA  chest  x-ray  and  electrocardiogram  can  suggest  large  tumors  or  those  causing  conduction  disturbances.  The  mainstay  of  diagnosis,  however,  is  echocardiography.  Transthoracic  echocardiography  is  an  excellent  screening  tool,  but  transesophageal  echocardiograaphy  can  provide  higher  resolution  and  more  information  about  the  dynamic  effects  of  the  mass  during  the  cardiac  cycle  and  the  precise  location  of  the  tumor.  Computed  tomography  (CT)  scan  and  magnetic  resonance  imaging  (MRI)  are  also  useful  in  further  characterizing  cardiac  masses  and  determining  the  depth  of  invasion  in  cases  of  malignant  lesions.TreatmentThe  mainstay  of  treatment  for  the  vast  majority  of  cardiac  tumors  is  surgical  excision.  Resection  should  be  performed  as  quickly  as  possible  after  diagnosis  given  the  risk  of  systemic  embolization.  Sarcomas  portend  a  poor  prognosis,  but  survival  can  be  improved  with  surgical  resection  when  technically  feasible.  In  addition,  some  studies  have  suggested  that  chemotherapy  and  radiation  therapy  may  enhance  survival.  Treatment  of  primary  cardiac  lymphomas  is  centered  on  chemotherapy  with  surgery  only  used  for  palliative  debulking.Outcomes  and  prognosisThe  prognosis  of  resectable  benign  tumors  is  usually  very  good  with  low  recurrence  rates  depending  on  the  type  of  tumor.  In  contrast,  the  prognosis  of  malignant  lesions  is  dismal  with  the  median  survival  being  only  6  to  18  months,  even  with  surgical  resection  or  transplant.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/17
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1104592845
ER  -