Primary and metastatic cardiac tumors: echocardiographic diagnosis, treatment and prognosis in a 15-years single center study

Nomoto, Natsumi; Tani, Tohru; Konda, Toshiko; Kim, Kitae; Kitai, Takeshi; M, Ota; Kaji, Shuichiro; Imai, Yukihiro; Okada, Yukikatsu; Furukawa, Yutaka

doi:10.1186/s13019-017-0672-7

Cited by 51 publications

(57 citation statements)

References 18 publications

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“…Nomoto and coworkers [7] reported a prevalence of 64% for primary cardiac tumors in 61 patients in a 15year prospective study. The reported mean age was 65 years.…”

Section: Discussionmentioning

confidence: 98%

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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“…Nomoto and coworkers [7] reported a prevalence of 64% for primary cardiac tumors in 61 patients in a 15year prospective study. The reported mean age was 65 years.…”

Section: Discussionmentioning

confidence: 98%

Primary cardiac tumors: a spectrum of pathologies and scenarios

et al. 2020

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“…TTE is useful in the initial evaluation of suspected cardiac disease, but sometimes transesophageal echocardiography is required for a more accurate assessment [29]. The diagnostic accuracy of echocardiography is around 80% in the evaluation of suspected cardiac tumors [30]. CT and magnetic resonance imaging provide additional detail of the surrounding extracardiac structures, including the lungs, mediastinum and pleura [31].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Pitfalls: Intramyocardial Lymphoma Metastasis Mimics Acute Coronary Syndrome in A Diffuse Large B Cell Lymphoma Patient – Case Report

Prenek

Csupor

Besztercán

et al. 2020

Preprint

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Background: Cardiac tumors are very uncommon compared to other cardiac diseases. Their clinical symptoms can vary from absent to nonspecific. The most common symptoms are arrhythmias, blood flow obstruction due to valvular dysfunction, shortness of breath, systemic embolization, accumulation of pericardial fluid. Hereby, we describe a very rare case of a diffuse large B cell lymphoma patient who presented with the symptoms and signs of acute coronary syndrome (ACS) but the patient’s complaints were caused by his intramyocardial lymphoma metastasis.Case presentation: 48-year-old diffuse large B cell lymphoma patient was admitted to our emergency department with chest pain, effort dyspnea and fever. The patient had normal blood pressure, blood oxygen saturation, sinus tachycardia, fever, crackles over the left lower lobe, novum incomplete right bundle branch block with Q waves and minor ST alterations, elevated C-reactive protein, high-sensitivity troponin-T and d-dimer levels. Chest X-ray revealed consolidation on the left side and enlarged heart. Bed side transthoracic echocardiography showed inferior akinesis with pericardial fluid. Coronary angiography showed no occlusion or significant stenosis. Chest computed tomography demonstrated the progression of his lymphoma in the myocardium. He was admitted to the Department of Hematology for immediate chemotherapy and he reached complete metabolic remission, followed by allogeneic hematopoietic stem cell transplantation. Unfortunately, about 9 months later, he developed bone marrow deficiency consequently severe sepsis, septic shock and multiple organ failure what he did not survive.Conclusions: Our case demonstrates a very rare manifestation of a heart metastasis. ACS is an unusual symptom of cardiac tumors. But our patient’s intramyocardial lymphoma in the right atrium and ventricle externally compressed the right coronary artery, causing the patient’s symptoms which imitated ACS. Fortunately, the quick diagnostics and immediate aggressive chemotherapy provided the patient’s remission and suitability to further treatment.

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“…The majority of cardiac tumors (75%) are benign, while the remaining quarter are malignant . PFEs are the second most common type of benign primary cardiac tumor, ranging from 10% to 23% in prevalence . The overwhelming majority of PFEs are associated with valvular structures, making up over three‐fourths of cardiac tumors which are found on valves .…”

Section: Discussionmentioning

confidence: 99%

Robotic totally endoscopic excision of aortic valve papillary fibroelastoma: The least invasive approach

2019

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Introduction: Papillary fibroelastomas (PFEs) are a rare subtype of benign primary cardiac tumors, which are most commonly found on the aortic valve (AV). They have the potential to cause severe adverse clinical consequences, thus prompting surgical excision in the majority of cases. In this article, we report on a series of 5 PFEs resected from the AV using a robotic-assisted sternal-sparing approach, and review of the literature on this approach. To our knowledge, this is the largest reported series of robotic-assisted sternal-sparing AV-PFE resections.Materials and Methods: From May 2016 until November 2018, 5 patients at our institution underwent removal of a papillary fibroelastoma from the aortic valve using a totally endoscopic robotic-assisted approach. After obtaining institutional IRB approval, we retrospectively reviewed their data for this report. We additionally contacted the patients to acquire a last clinical follow up for this study. Results In this series of 5 patients who underwent robotic totally endoscopic excision of AV PFE, all patients had successful removal of their tumor with no significant morbidity or mortality. All 5 patients were seen at a 30-day follow-up office visit, at which time they had recovered from surgery and were back to full activity. At a mean of 24 months all patients were doing well and free of symptoms with no evidence of tumor recurrence on repeat echo evaluation.Discussion: This is a series of 5 patients with AV-associated PFEs who underwent robotic totally-endoscopic excision without rib-spreading or conversion to sternotomy. This report demonstrated the successful application of robotic-assisted technology in aortic valve pathology. All PFEs were successfully removed without valve repair or replacement. We were able to offer a safe, curative, minimally-invasive surgical excision option for this group of patients. Conclusion:Our patients in this cohort demonstrated the well-established benefits of robotic sternal-sparing cardiac surgery, including excellent intra and postoperative outcomes and accelerated recovery. K E Y W O R D S cardiac fibroelastoma, robotic, valve repair/replacement

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Primary and metastatic cardiac tumors: echocardiographic diagnosis, treatment and prognosis in a 15-years single center study

Cited by 51 publications

References 18 publications

Primary cardiac tumors: a spectrum of pathologies and scenarios

Primary cardiac tumors: a spectrum of pathologies and scenarios

Diagnostic Pitfalls: Intramyocardial Lymphoma Metastasis Mimics Acute Coronary Syndrome in A Diffuse Large B Cell Lymphoma Patient – Case Report

Robotic totally endoscopic excision of aortic valve papillary fibroelastoma: The least invasive approach

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