Clinical Treatment of Pediatric Primary Cardiac Tumors: A Single-Institute 12-Year Experience

Abstract

Background: Primary cardiac tumors in children are extremely rare. This study aimed to analyze clinical treatment and follow-up of pediatric primary cardiac tumors. Patients and Methods: We performed a retrospective analysis by searching the medical records of 75 patients diagnosed with pediatric primary cardiac tumors from June 2005 to August 2017 in our institution. We followed operative patients every half year in the first postoperative year and then at least every year. If the patients had no serious symptoms or hemodynamic changes, they received nonoperative management and were followed regularly every year. Results: Nineteen patients underwent surgery at our department for serious symptoms and critical hemodynamic changes. Four patients had postoperative complications. Two died of low cardiac output syndrome and arrhythmia after surgery. One patient with myxomas had tumor recurrence and one had been found of another rhabdomyoma after surgery. The other 14 patients recovered well. Fifty-six patients had nonoperative management. Four were lost in follow-up. Two patients with malignant tumors died of unknown causes after discharge. The remaining patients had no severe symptoms or tumor growth during follow-up. Conclusions: Clinical treatment of pediatric primary cardiac tumors should be performed individually. Most pediatric primary cardiac tumors are benign, and spontaneous regression is possible, especially for rhabdomyomas. The principle purpose of surgical treatment is to restore normal hemodynamics and protect important structures and cardiac tissue.

Current status of diagnosis and treatment of primary benign cardiac tumors in children

“…CR occurs almost exclusively in children, mainly before age 1, and can also be found in fetus, with no significant sex predilection (2,4,10). In a retrospective analysis by Słowińska et al (29) CR was detected prenatally in 71/100 cases (71%), and 82/100 cases (82%) were diagnosed within 4 months after birth.…”

“…The current nomenclature and classification of cardiac tumors mainly adopt the World Health Organization (WHO) classification of cardiac tumors (Fourth Edition) (7). Unlike the incidence in adults, the most frequent tumors reported in children were rhabdomyoma, followed by fibroma, myxoma, teratoma, and hemangioma (1,4,8). When analyzing the ageadjusted prevalence of tumors, rhabdomyoma, hemangioma, and fibroma were more common among infant, while myxoma was more common among children over 1 year old (8).…”

“…It is worth noting that compared with adults, infants and young children have smaller and thinner heart walls, increased load after tumor resection, decreased contractility, and are more prone to hemodynamic complications. Therefore, the surgical plan needs to be individually formulated (4,51); Gentle manipulation of the heart is required during the procedure to prevent the mass from breaking up and embolizing. Tumors should be resected through the natural channel whenever possible, avoiding ventricular incision, especially the left ventricle.…”

“…A higher percentage of tumor relapse was noted for myxoma and teratoma (4,8). In recent years, literature reports have shown that with the advancement of medical technology, the detection rate and successful treatment rate of cardiac tumors have increased year by year, and surgical techniques have been improved.…”

“…Due to the development of non-invasive imaging modalities in recent years, the reports of primary cardiac tumors have gradually increased. Among these diagnosed cardiac tumors, benign tumors account for approximately 90% (3,4). In a retrospective analysis by Morka et al (1) in Poland, 95.1% of children diagnosed with a heart tumor were determined to be benign primary cardiac tumors in multiple centers over 15 years.…”