Mortality and Embolic Potential of Cardiac Tumors

Abstract

BackgroundCardiac tumors are rare, mostly benign with high embolic potential.ObjectivesTo correlate the histological type of cardiac masses with their embolic potential, implantation site and long term follow up in patients undergoing surgery.MethodsBetween January 1986 and December 2011, we retrospectively analyzed 185 consecutive patients who underwent excision of intracardiac mass (119 females, mean age 48±20 years). In 145 patients, the left atrium was the origin site. 72% were asymptomatic and prior embolization was often observed (19.8%). The diagnosis was established by echocardiography, magnetic resonance and histological examination.ResultsMost tumors were located in the left side of the heart. Myxoma was the most common (72.6%), followed by fibromas (6.9%), thrombi (6.4%) and sarcomas (6.4%). Ranging from 0.6cm to 15cm (mean 4.6 ± 2.5cm) 37 (19.8%) patients had prior embolization, stroke 10.2%, coronary 4.8%, peripheral 4.3% 5.4% of hospital death, with a predominance of malignant tumors (40% p < 0.0001). The histological type was a predictor of mortality (rhabdomyomas and sarcomas p = 0.002) and embolic event (sarcoma, lipoma and fibroelastoma p = 0.006), but not recurrence. Tumor size, atrial fibrillation, cavity and valve impairment were not associated with the embolic event. During follow-up (mean 80±63 months), there were 2 deaths (1.1%) and two recurrences 1 and 11 years after the operation, to the same cavity.ConclusionMost tumors were located in the left side of the heart. The histological type was predictor of death and preoperative embolic event, while the implantation site carries no relation with mortality or to embolic event.

Acidente vascular cerebral transitório como forma de apresentação de mixoma auricular

“…Achados menos frequentes são a leucocitose, a trombocitopenia, a cianose, o baqueteamento digital e o fenómeno de Raynaud. Os sintomas sistémicos remitem após excisão tumoral 5,6,8 . Ao exame físico, mais de metade dos doentes podem apresentar sopros sistólicos ou diastólicos, dependendo do tamanho, localização e mobilidade do mixoma, assim como da posição do doente.…”

“…A tomografia axial computorizada, ressonância magnética e, por vezes, a angiografia coronária, podem complementar o estudo diagnóstico e contribuir para a planificação da estratégia terapêutica. O diagnóstico definitivo é realizado após excisão tumoral e avaliação anátomo-patológica, apoiada pela avaliação imuno-histoquímica [5][6][7][8] . O tratamento de eleição dos mixomas cardíacos é a excisão cirúrgica, sendo geralmente curativa.…”

Evaluation of the potential predictors of embolism in patients with left atrial myxoma

“…were found to be associated with a higher risk of embolic events in the univariate analysis. Dias et al 16 reported that the tumor size, atrial fibrillation, and valve impairment were not associated with the embolic events. On the other hand, Liang et al showed that patients who developed embolic events had significantly larger cardiac myxomas and left atrial diameters.…”

Left atrial myxoma complicated by acute embolism to the left subclavian artery

“…Systemic embolisation occurs in around 30% of cases either from tumour fragmentation or complete tumour detachment. Cerebral embolism is the most common site followed by coronary, renal, mesenteric and peripheral arteries 2. Embolisation of cardiac myxoma to peripheral arteries leading to acute limb ischaemia has rarely been reported before 3.…”