Twenty years experience in oncologic surgery for primary cardiac tumors

Abstract

Introduction: Primary cardiac tumors are uncommon in cardiac surgery. To investigate the clinical presentation, surgical results and long-term follow-up we retrospectively analyzed our experience in the treatment of primary cardiac tumors.

Patients and methods: Ninety-one patients with primary cardiac tumors underwent surgery in our department in the last 20 years. Fifty-one patients were female, the mean age was 62,2 years. Sixty-three had myxomas, 22 had papillary fibroelastoma, 4 had malignant neoformations and 2 had other benign tumors.

Results: All myxomas, fibroelastomas and angiomyolipoma were radically removed. Only a palliative treatment was possible in malignant disease. In-hospital mortality was 1.2%. The mean follow-up time was 78.5 months. Three patients had recurrence of myxoma, all patients with malignant disease dead during the follow-up.

Discussion: Primary benign cardiac tumors can be treated with low morbidity and mortality. The follow-up demonstrates that radical surgery is curative in case of benign tumors. The prognosis of malignant tumors is still poor. Palliative procedures have small impact on survival in these patients.

Fig. 1

A, B) Preoperative echocardiography showing clearly the mechanism of obstruction of the mitral valve. C) Papillary fibroelastoma of the right aortic leaflet (white arrow) in a patient with previous embolic acute myocardial infarction. D) Papillary fibroelastoma of the right interventricular septum in a patient with malignant arrhythmia. E) Papillary fibroelastoma of the tricuspid valve. F) Recurrent myxoma of the left atrial wall after 29 months from the first surgery.

Fig. 2 - A–F)

A) Cardiac magnetic-resonance T2-weighted of the patient with HMCM, showing a mildly hyperintense mass on the inferior wall if the left ventricle involving the base of the posterior-medial papillary muscle (arrow). B) Intraoperative view of HCMC, on the postero-inferior-basal surface became evident a whitish and translucent area not clearly demarcated from the normal myocardial tissue(arrow). C) Operative specimen of a typical cardiac myxoma. D) Operative specimen of a tipical papillary fibroelastoma. E) Angiomyolipoma of the interventricular septum. The neoplasm originated in the thickness of the septum and became evident only after the incision of endocardium. F) Intraoperative view of a papillary fibroelastoma originating from second order chorda of the anterior leaflet of the mitral valve.