Operaciones inusuales en cirugía cardiaca infantil: resección de masas intracardiacas

Abstract

IntroductionDiscovering an intracardiac mass in pediatrics needs a differential diagnosis between tumours (primary/secondary) and thrombi, all being uncommon in children. We present our surgical experience resecting intracardiac masses in children. MethodsWe indicate intracardiac mass excision when it causes symptoms or has hemodynamic consequences by obstructing blood flow. Retrospective study: 12 children operated from 2011 to 2022. Statistical analysis: SPSS® v. 20.0. ResultsMean age: 7,1±6 years, 67% female. Two children had previous congenital heart disease repair and 5 oncologic pathology; 2 had anomalous coagulation test. Asymptomatic 67% and symptomatic 33%. Echocardiogram was performed in 100% and magnetic resonance in 50%: Obstructive mass located in the right atrium in 6 patients, tricuspid valve in 2, right ventricle in 2 and left ventricle in other 2. Associated lesions: patent foramen ovale (5), moderate tricuspid regurgitation (3) and severe pulmonary/subaortic stenosis (2). Two patients had a right renal tumor with intracardiac extension through the inferior vena cava. Surgery performed by sternotomy (11) or thoracotomy (one), with extracorporeal circulation (4 with beating heart), achieving removal of the whole mass (11) or partial (one). Mean extracorporeal circulation and aortic clamp times: 72±44 and 34±33min, respectively. Mean intubation 7±7h and postoperative stay 11±6 days. Two patients presented postoperative complications (ascites and pericardial effusion). Pathological anatomy of the explanted masses: 4 thrombi, 2 fibromas, 2 nephroblastomas, one myxoma, one rhabdomyoma, one papillary fibroelastoma and one inflammatory pseudotumor. No hospital or late mortality. No subsequent reoperations. Mean follow-up 4.8±3.7 years (maximum 10 years). ConclusionsWe recommend removing any intracardiac mass that significantly obstructs blood flow or causes symptoms, in order to improve clinically and determine the etiology of the mass. Our surgical results are good, without mortality or reintervention in subsequent follow-up.