Long-Term Efficacy Analysis of Surgical Resection of 70 Primary Right Heart Tumors

Abstract

Introduction: The aim of the study was to investigate the clinical characteristics, surgical treatment, and long-term efficacy of primary right heart tumors.

Methods: This study is retrospective analysis of the clinical data of 70 patients with primary right heart tumors admitted to our department between 1980 and 2022 (observation group) and 70 patients with left heart tumors during the same period (control group). The surgical treatment was performed under cardiopulmonary bypass after differential diagnosis by echocardiography, cardiac CTA, and PET-CT before the surgery. The perioperative characteristics, recurrence rate, and long-term survival rates of right heart tumor versus left heart tumor were compared.

Results: The most common pathological types of right heart tumors were myxoma (60%), lipoma (8.57%), and papillary elastofibroma (7.14%). During the perioperative period, there were 1 case of systemic embolism in the observation group, compared with 6 in the control group (p = 0.026), 13 cases of malignant tumor in the observation group versus 1 in the control group (p = 0.01). During the follow-up period, there were 15 cases of tumor recurrence and 17 cases of death in the observation group versus 4 (p = 0.002) and 7 in the control group (p = 0.006), comparatively.

Conclusion: Compared with left heart tumors, primary right heart tumors had a higher incidence of malignant tumors and a lower risk of systemic embolism during perioperative period. During the follow-up period, primary right heart tumors had a higher rate of tumor recurrence and a lower long-term survival rate.

Keywords: Heart tumors; Pathological results; Primary right cardiac tumor; Tumorectomy; Valvoplasty.

Fig. 1.

Distribution of tumor types in the observation group (n = 70).

Fig. 2.

Results of survival analysis during the follow-up period. a Blue indicated the survival rate in the observation group, black indicated the survival rate in the control group (p = 0.006). b Blue indicated the recurrent rate in the observation group, black indicated the recurrent rate in the control group (p = 0.002). When p < 0.05, it indicates a significant difference between groups.

Fig. 3.

Patient with lipomyoma (case 1). a Cardiac ultrasound, with the arrow indicating that large pulmonary valve tumor blocked right ventricular outflow tract. b Tumor resected during surgery (10*5.5*4.5 cm³) growing from the pulmonary valve, with the arrow indicating the pulmonary valve. MPA, main pulmonary artery; AO, aorta; RPA, right pulmonary artery; LPA, left pulmonary artery.

Fig. 4.

Patient with papillary elastofibroma (case 2). a Cardiac CTA, with the arrow indicating the space-occupying lesion located in the right atrium. b Intraoperative pictures, with the arrow indicating the tumor. RA, right atrium; RV, right ventricle; DAO, descending aorta; LA, left atrium; LV, left ventricle; RAA, right atrium appendage; PTS, posterior tricuspid leaflet.

Fig. 5.

Patient with intravenous leiomyoma and angiosarcoma (cases 3 and 4). a Thoracoabdominal aortic CTA, with the arrow indicating the space-occupying lesion located in the inferior vena cava. b Cardiac CTA, with the arrow indicating the tumor located from the right ventricular wall to the tricuspid annulus (a RK, right kidney; LK, left kidney; DAO, descending aorta; LV, lumbar vertebra) (b RA, right atrium; RV, right ventricle; LV, left ventricle; TV, thoracic vertebra; IVS, interventricular septum; DAO).