Protean clinical manifestations of primary tumors of the heart

Abstract

A series of thirteen primary tumors of the heart is reported, with emphasis upon the diagnostic features. Included are nine patients with myxomas of the left atrium, one with myxoma of the left ventricle, one with myxoma of the right atrium and two with other cardiac tumors. In patients with myxomas of the left atrium clinical findings imitated a variety of cardiac lesions; they were typical of pure mitral stenosis in three, of combined stenosis and regurgitation of the mitral valve in two and of pure mitral regurgitation in two. One patient had unexplained cardiac failure without murmurs and was thought to have cardiomyopathy. One patient had no evidence of cardiac disease but did have systemic emboli. The patient with left ventricular myxoma had features suggesting hypertrophic subaortic stenosis. The patient with right atrial myxoma had severe cyanosis and polycythemia, suggesting the cyanotic form of congenital heart disease. In the patient with right ventricular teratoma, symptoms suggested the presence of infundibular pulmonary stenosis; one patient with a left ventricular fibroma was thought to have an unusual form of congenital heart disease. The various features alleged to be characteristic of myxomas are seldom combined in a single case. Consequently the variability of the clinical features of cardiac tumors should be kept in mind; angiocardiographic examinations, capable of positively identifying such tumors, should not be omitted in any patient with valvular heart disease who shows unusual features or in those with obscure cardiac problems.