Clinicopathological and surgical experience with primary cardiac tumors

Abstract

Intracardiac tumors are rare neoplasms that present with clinical features of obstruction, embolization, conduction disturbances, and constitutional symptoms. Complete surgical resection under cardiopulmonary bypass offers the best prospect of disease-free survival. Data of 30 consecutive patients who underwent resection of an intracardiac mass at St. Vincent's Hospital from 1990 to 2012 were reviewed. The patients presented with dyspnea (33%), palpitations or arrhythmias (20%), and recurrent pulmonary edema (6%). There was a history of embolic stroke in 46%. Intracardiac masses were identified using preoperative echocardiography. Resection was performed on cardiopulmonary bypass via a modified Dubost (superior transseptal) approach in 78%, a left atriotomy in 11%, and a biatrial approach in 5%. Twenty-eight (93%) masses were identified as neoplastic, predominantly myxomas (62%). There was no mortality at 30 days. On long-term follow-up (mean 9 years, range 1-19 years) there were 5 deaths; 83% of patients were still alive. Cardiac tumors are rare and an important differential diagnosis in the context of unexplained obstructive symptoms, emboli, and conduction abnormalities. Myxomas are the most common cardiac neoplasm. Solid tumors are more common, more likely to be associated with heart failure, and best excised in one whole part, whereas papillary tumors are more likely to be associated with neurological symptoms, and more likely to be resected by piecemeal removal. Prompt and complete resection under cardiopulmonary bypass is the safest approach.