Surgical Experience of Primary Cardiac Tumor: Single-Institution 23-Year Report

Li, Shuanglei; Gao, Changqing

doi:10.12659/msm.903324

Cited by 22 publications

(17 citation statements)

References 18 publications

(23 reference statements)

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“…Most commonly noted post-operative complications with cardiac lipoma excision include arrhythmias, pneumonia and bleeding. In addition, cardiac lipoma may recur[ 16 , 17 ]. With our patient’s unusual tumor features and location in addition to, several comorbidities, surgical resection was proscribed and symptom management with antiarrhythmics showed only limited success.…”

Section: Discussionmentioning

confidence: 99%

Tale of fat and fib — cardiac lipoma managed with radiofrequency ablation: A case report

Nalluru

Nadadur

Trivedi

et al. 2020

WJC

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BACKGROUND Cardiac lipoma and lipomatous hypertrophy of interatrial septum (LHIS) are very rare disorders with distinct pathological features. While cardiac lipoma is a well-circumscribed encapsulated tumor of mature adipocytes, LHIS is due to entrapment of fat cells in the interatrial septum during embryogenesis. Although a biopsy is the definitive diagnostic test, these disorders can be differentiated by a cardiac magnetic resonance imaging (MRI). Treatment of LHIS is not warranted in asymptomatic patients. In symptomatic patients, surgical resection is the only recommended treatment, which has shown to improve good long-term prognosis. CASE SUMMARY A 63-year-old Caucasian woman with past medical history significant for hypertension, hypothyroidism, right breast ductal cell carcinoma treated with mastectomy and breast implant, platelet granule disorder, asthma requiring chronic intermittent prednisone use, presented to the outpatient cardiology office with recent onset exertional dyspnea, palpitations, weight gain and weakness. Initial workup with electrocardiogram and holter monitor did not reveal significant findings. During the subsequent hospitalization for community acquired pneumonia, the patient developed symptomatic paroxysmal atrial fibrillation. Transthoracic echocardiogram showed a right ventricular mass. A biopsy was not pursued given the high risk of bleeding due to platelet granule disorder. Cardiac MRI showed characteristic features consistent with cardiac lipoma and LHIS. Prednisone was discontinued. Genetic testing for arrhythmogenic right ventricular dysplasia and 24-h urine cortisol test was negative. As multiple attempts at rhythm control failed with sotalol and flecainide, pulmonary vein isolation and right atrial isthmus radiofrequency ablation were done. She is in follow-up with symptomatic relief and no recurrence of atrial fibrillation for 10 mo. CONCLUSION Benign fatty lesions in heart include solitary lipoma, lipomatous infiltration and lipomatous hypertrophy of interatrial septum. Although transvenous biopsy provides a definitive diagnosis, Cardiac MRI is superior to computed tomography and aids in differentiating benign from malignant lesions. Surgical excision of cardiac lipoma along with capsule and pedicle removal generally prevents recurrence, but with our patient’s unusual tumor features and comorbidities proscribed a surgical approach. Symptom management with antiarrhythmics and ablation techniques were successfully utilized.

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Section: Discussionmentioning

confidence: 99%

Tale of fat and fib — cardiac lipoma managed with radiofrequency ablation: A case report

Nalluru

Nadadur

Trivedi

et al. 2020

WJC

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“…The incidence of primary cardiac tumors varies between 0.001 and 0.03%, and 0.3-0.85% of all open-heart surgeries are for cardiac tumor resections [4,5]. Twenty-five percent of primary cardiac tumors are malignant, with sarcoma accounting for a majority of the reported cases [6]. Most of the primary cardiac tumors reported in our series of 82 patients were benign (91%), and atrial myxoma was the most common type (87%).…”

Section: Discussionmentioning

confidence: 99%

“…For malignant cardiac tumors, however, the literature reports a dismal prognosis [8]. Survival rates vary from 7 months to a maximum of 2 years from diagnosis [6,8]. On long-term follow-up, the majority of patients die of distant metastases.…”

Section: Discussionmentioning

confidence: 99%

Primary cardiac tumors: a spectrum of pathologies and scenarios

et al. 2020

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Background: Cardiac tumors are rare, and their diagnosis is challenging. The level of evidence for the management of cardiac tumors came from case reports or small case series. We aim to present our multicenter experience in the diagnosis and management of cardiac tumors. Results: We performed a prospective study, including 82 cases of cardiac tumors encountered at three centers in 5 years. The mean age was 62 ± 5.8 years old (range 2 months-74 years), and 91.4% were females constituted. The median EuroSCORE II was 4.27%. All cases underwent radical excision of the tumor. Five cases underwent additional mitral valve replacement and one case underwent coronary bypass grafting. Pathological diagnoses were left atrial myxomas (n = 65, 79.3%), right atrial myxomas (n = 5, 6.1%), bi-atrial myxomas (n = 2, 2.4%), right ventricular outflow tract myxoma (n = 1, 1.2%), myxosarcoma (n = 1, 1.2%), thymoma (n = 1, 1.2%), recurrent hemangioendothelioma (n = 1, 1.2%), round cell tumor (n = 1, 1.2%), cardiac lymphoma (n = 1, 1.2%), rhabdomyomas (n = 2, 2.4%), and renal cell carcinomas (n = 2, 2.4%). Two patients (2.4%) had re-exploration for bleeding. One patient (1.2%) with right atrial thymoma experienced a severe vasoplegia with unstable hemodynamics. Two patients had operative mortality (2.4%), one with recurrent cardiac hemangioendothelioma. During 1-year follow-up, one patient (1.2%) died because of metastatic myosarcoma. Recurrence was reported in 2 patients (2.4%). Conclusions: The clinical scenario of cardiac tumors depends mainly on tumor location and size rather than the histopathology. Surgical resection is feasible in benign tumors while very challenging in malignant tumors.

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“…Li et al, 26 reported a single-institution, 23-year report of the resection of primary cardiac tumours in 228 patients. Within the cohort, there were 156 traditional open operations, 60 robotic neoplasm resections, and 12 procedures performed through mini-thoracotomy.…”

Section: Other Proceduresmentioning

confidence: 99%