Resection Of Cardiac Tumors Research Articles

A 20-Year Experience With Resection of Primary Cardiac Tumors and Metastatic Tumors of the Heart

Cardiac tumors are uncommon, occurring in less than 1% of the population, and are comprised of numerous tumor types. Management of certain tumors types such as sarcoma have evolved and improved in the recent era. We evaluate the outcomes of patients who underwent resection of benign or malignant cardiac tumors with a focused review of cardiac sarcomas. Institutional data were reviewed from 1997 to 2017, and 180 patients who underwent tumor resection were identified. Outcomes and survival were examined based on tumor type. Two-thirds of patients (119 of 180) had benign tumors. Of 61 malignant tumors, 23 were sarcomas, 24were cavoatrial tumors, and 8 were T4 lung tumors. Inthe sarcoma group, operative mortality was 2 of 23 (9.1%). Neoadjuvant therapy was administered to 8 of 23patients (34.8%) with R0 resection achieved in 5 of 8 patients (62.5%). R0 resection was successful in 7 of 15 patients (46.7%) without neoadjuvant therapy. Mean survival with neoadjuvant therapy was 2.76 ± 3.85 years versus 1.28 ± 1.31 years without neoadjuvant therapy (p= 0.428). Mean survival with R0 resection was 2.79 ± 4.23 years compared with 1.64 ± 1.63 years without (p= 0.407). In the T4 lung tumor group, operative mortality was zero and R0 resection was achieved in 6 of 8 (75%). The cavoatrial tumors were mostly renal cell carcinoma resected with a mortality of 4.5%. Cardiac tumors are comprised of diverse tumor types. Indications for, and benefits of, resecting benign tumors and many malignant tumor types are clear, and operative outcomes are generally good. Cardiac sarcomas benefit from neoadjuvant therapy, which improves the rate of complete resection, thus improving survival.

Early and late results in surgical excision of primary cardiac tumors: Our single-institution experience.

In the present study, we present our experience for surgical excision for cardiac masses and to analyze survival characteristics of these patients. Between January 2004 and December 2015, a total of 131 patients (88 females, 43 males; mean age 49.4±16.2 years; range, 1.2 months to 81 years) with primary cardiac tumors who underwent surgery in our center were included in this study. Demographic and other patient-related data were retrospectively reviewed from medical records of our center. All benign tumors were completely resected, whereas only palliative procedures were performed for malignant tumors. Pathology results revealed 88.5% (n=116) benign and 11.5% (n=15) malignant tumors. Tumors were most frequently located in the left atrium (76.3%, n=100), followed by the right atrium (11.5%, n=15), and the right ventricle (5.3%, n=7). Among all patients, 116 (88.5%) survived, while late mortality was seen in 15 patients (11.5%). The mean survival was 130.6±4.5 months. The latest mortality was observed at 124 months, whereby the cumulative survival rate was 79.2%. There was a statistically significant relationship between mortality and pathological characteristics of the tumor, and malignant cases had significantly higher mortality rates (p=0.002). Surgical resection of primary cardiac tumors can be performed with low morbidity and mortality rates. Although survival rates in benign tumors are satisfactory, patients with malignant tumors have poor prognosis. The main clinical predic.

Clinicopathologic features and outcomes of primary cardiac tumors: a 16-year-experience with 212 patients at a Chinese medical center.

Primary cardiac tumors are uncommon, and the majority of them are benign which are curable but can cause significant morbidity if not diagnosed and treated in a timely fashion. The objective of this study was to review the clinicopathologic features and surgical outcomes of patients with primary cardiac tumors in a single medical center in China. We have retrospectively reviewed 212 consecutive adult patients who underwent surgical resection of primary cardiac tumors at our center from January of 2001 to June of 2017. All available clinicopathological features, imaging characteristics, and disease outcomes were summarized and presented. The present series enrolled 180 cardiac myxomas (84.9%) and 32 non-myxoma cases that included hemangioma, lipoma, papillary fibroelastoma, schwannoma, pericardial cyst, teratoma, paraganglioma, lymphoma, undifferentiated pleomorphic sarcoma, myxofibrosarcoma, angiosarcoma, and liposarcoma. All patients were diagnosed ante-mortem. The most frequent complaint was dyspnea. Benign tumors accounted for 93.9% of cases (199/212) and malignant tumors accounted for 5.7% (12/212), and the remaining one case was intermediate (paraganglioma). The outcome of benign tumors was favorable and only three recurrent cases were documented (1.5%) after surgical resection. All the seven patients with primary cardiac sarcomas (undifferentiated pleomorphic sarcoma, myxofibrosarcoma, angiosarcoma, and liposarcoma) suffered postoperative recurrence or disease related death. Cardiac myxoma represents the most frequent primary cardiac tumors. The clinical presentations, treatment strategies and outcomes of the primary cardiac tumors depend on the tumor location and histopathological type.

Outcomes After Surgical Resection of Primary Non-Myxoma Cardiac Tumors.

ObjectivePrimary cardiac tumors are rare lesions with different histological type. We reviewed our 17 years of experience in the surgical treatment and clinical results of primary non-myxoma cardiac tumors.MethodsBetween July 2000 and February 2017, 21 patients with primary cardiac tumor were surgically treated in our institution. The tumors were categorized as benign non-myxomas and malignants. Data including the demographic characteristics, details of the tumor histology and grading, cardiac medical and surgical history, surgical procedure of the patients were obtained from the hospital database.ResultsEleven patients were diagnosed with benign non-myxoma tumor (male/female:7/4), ranging in age from 10 days to 74 years (mean age 30.9±26.5 years). Papillary fibroelastoma was the most frequent type (63.6%). There were two early deaths in benign group (all were rhabdomyoma), and mortality rate was 18%. The mean follow-up period was 69.3±58.7 months (range, 3 to 178 months). All survivals in benign group were free of tumor-related symptoms and tumor relapses. Ten patients were diagnosed with malignant tumor (sarcoma/lymphoma:8/2, male/female:3/7), ranging in age from 14 years to 73 years (mean age 44.7±18.9 years). Total resection could be done in only three (30%) patients. The mean follow-up period was 18.7±24.8 months (range, 0-78 months). Six patients died in the first 10 months.ConclusionComplete resection of the cardiac tumors, whenever possible, is the main goal of surgery. Surgical resection of benign cardiac tumors is safe, usually curative and provides excellent long-term prognosis. On the contrary, malignant cardiac tumors still remain highly lethal.

Surgery for Tumors of the Heart

Most surgeons will encounter only a handful of primary cardiac tumors outside of myxomas. Approximately 3 quarters of primary cardiac tumors are benign and 1 quarter is malignant. In most cases, cardiac tumors are silent but when symptoms do occur, they are primarily determined by tumor size and anatomical location, not by histopathology. The diagnosis and preoperative imaging relies heavily on multimodal imaging including echocardiography, computed tomography, magnetic resonance imaging, and coronary angiography. Surgical resection is the most common treatment for most simple primary cardiac tumors and for some complex benign tumors. Surgical resection of primary cardiac tumors frequently involves the need for complex cardiac reconstruction, particularly when malignant. Secondary tumors to the heart are 30 times more frequent than primary cardiac tumors, and their incidence is increasing, largely as a result of advances in cancer diagnosis and therapy. Surgical resection is feasible in only a small fraction of highly-selected patients with secondary tumors to the heart. For complex benign tumors-such as paraganglioma or large fibromas-and all primary and secondary malignant tumors, a multidisciplinary cardiac tumor team review in experienced centers of excellence is recommended.

Surgical Treatment of Cardiac Tumors: Insights from an 18-Year Single-Center Analysis.

BackgroundThe aim of this study was to investigate the clinical presentation, operative data, and early and late outcomes of a large patient cohort undergoing surgical treatment for cardiac tumors in our institution.Material/MethodsA total of 181 patients underwent surgery because of suspected cardiac tumor in our institution between 1998 and 2016. In 162 cases, the diagnosis was confirmed postoperatively and these patients were included in this study. Preoperative baseline characteristics, operative data, and postoperative early and long-term outcomes were analyzed.ResultsMean age at presentation was 56.6±17.6 years, and 95 (58.6%) patients were female. There were 126 (77.8%) patients with benign cardiac tumors, while the remaining patients had malignant tumors (primary and metastasized). The mean follow-up time was 5.2±4.7 years. The most frequent histologically verified tumor type was myxoma (63%, n=102). In terms of malignant tumors, various types of sarcomas presented most primary malignant cardiac tumors (7.4%, n=12). The mean ICU length of stay was 1.7±2.2 days and overall in-hospital mortality was 3.1% (n=5). Frequent postoperative complications included mediastinal bleeding (5.8%, n=9), wound infection (1.3%, n=2), acute renal failure (5.6%, n=9), and major cerebrovascular events (n=7, 4.6%). The overall cumulative survival after cardiac tumor resection was 94% at 30 days, 85% at 1 year, 72% at 5 years, and 59% at 15 years.ConclusionsSurgical treatment of cardiac tumors is a safe and highly effective strategy associated with good early and long-term outcomes.

Primary cardiac sarcoma complicated with cerebral infarction and brain metastasis: A case report and literature review

In large autopsy series, the estimated frequency of primary tumors of the heart ranges from 0.0017% to 0.33%. Approximately 25% of primary cardiac tumors are malignant, and nearly 20% of these are sarcomas. To date, a completely feasible surgical resection remains the major treatment measure of cardiac sarcoma, especially for recurrent focal cardiac sarcoma and the recurrence of a restrictive metastasis. Althoughcharacteristically medicaltreatments are recommended, there is no consistent opinion for adjuvant radiotherapy and chemotherapy following an operation. Since these tumors usually undergo extensive spread by the time that the diagnosis is established, the prognosis of cardiac sarcoma remains poor. In this report, we described a case who underwent initial cardiac tumor resection, and was confirmed to be a pleomorphic undifferentiated sarcoma based on pathological findings. However, the patient complicated with cerebral infarction and subsequent brain metastasis sarcoma after the initial surgery, which was confirmed by brain tissue pathology. During the course of therapy, the patient underwent three surgical operations and refused to accept any chemotherapy and radiotherapy intervention. To the best of our knowledge, this is the first case report describing a primary cardiac sarcoma complicated with cerebral infarction and brain metastasis. The management of primary cardiac sarcoma is also discussed.

Surgical Experience of Primary Cardiac Tumor: Single-Institution 23-Year Report.

BackgroundPrimary cardiac tumors are rare but have favorable surgical prognosis. Previous studies have been small series studies with limited surgical approaches. To date, few studies have examined the clinical features associated with different surgical procedures.Material/MethodsIn a search of the cardiovascular surgery database of our institution, we retrospectively identified 225 patients who had cardiac tumor resection from January 1993 to May 2016. The patients’ clinical characteristics and operation information were reviewed, and the operation parameters, postoperative complications, and short-term prognosis among robotic, mini-thoracotomy, and conventional procedures in our center were compared.ResultsA total of 228 operations were performed, including 156 traditional open surgeries (68.4%), 60 robotically assisted neoplasm resections (26.3%), and 12 mini-thoracotomy procedures (5.3%). Among 232 lesions, myxoma (94.8%) was the most common neoplasm, and the remainders were fibroma (1.3%) and lipoma (0.9%). Operative complications occurred in 36 patients (15.8%). Arrhythmia (8.8%) was the first common complication, and delayed mechanical ventilation (4.8%) ranked second. The overall risk of recurrence of myxoma was 2.7%. The cardiopulmonary bypass (CPB) time in the mini-thoracotomy group was longer than in the robotic group (p=0.034) and the conventional group (p=0.002). There were no significant differences in cross clamp time (p=0.266) or complications (p=0.835) among the three groups. The in-hospital survival rate was 100% in all patients. There were no significant differences in main adverse events among the three groups at six-month follow-up (p=0.285).ConclusionsPrognosis for cardiac neoplasm surgical resection is favorable for primary cardiac tumors. The minimally invasive surgery of cardiac tumor resection can be an alternative to conventional operations in selected patients.

Unusual Case of a Primary Cardiac Tumor Presenting as Superior Vena Cava Syndrome

SESSION TITLE: Student/Resident Case Report Poster - Cardiac and Thoracic Surgery SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Primary cardiac tumors are extremely rare. Incidence is approximately 0.017% - 0.019% of all primary tumors. Spindle Cell Sarcoma is the rarest, with only 4 cases reported. Sarcomas, have a poor prognosis even after surgical intervention with an average mean survival of 6 months. CASE PRESENTATION: 67 year old female patient with PMH of Hypertension, Dyslipidemia and DM that presented to the emergency department with complaints of swelling and redness of the face for one year that was treated as an allergic reaction without improvement. Presentation was significant for shortness of breath, dry cough, bilateral jugular vein distention, low voltage on EKG and a opacity measuring 3.8 x 3.7cm at the right hilar region on CXR. Chest CT confirmed a well-defined mass measuring 7 x 5.7cm in the right atrium producing extrinsic compression of the right atrioventricular valve and proximal aspect of the right ventricle. The mass infiltrated to the right hilar region invading pericardial fat. Additionally, the tumor was obliterating the Superior Vena Cava. Biopsy of the cardiac mass was positive for Spindle Cell Sarcoma. The patient was not a candidate for surgical resection due to advanced stage malignancy. Unfortunately, patient perished before starting chemotherapy. DISCUSSION: Primary cardiac tumors are mostly benign, 50% to 80% are Myxomas [1]. The remaining 25% of cardiac tumors are malignant, 95% are Sarcomas [2]. The most common malignant tumor is Angiosarcoma. Spindle Cell Sarcoma is the rarest, with only 4 cases reported [2]. Benign tumors usually have a good prognosis with a normal life expectancy after surgical resection. Patients with malignant tumors have a poor prognosis even after surgical intervention, with an average mean survival of 6 months after diagnosis [3]. Diagnosis is made with imaging techniques such as: 2D echocardiogram, cardiac CT, MRI and confirmed with tissue biopsy [3]. Complete resection of the tumor remains the best treatment available with or without adjuvant chemotherapy [3]. CONCLUSIONS: Spindle Cell Sarcoma may present with few symptoms and may remain silent until an advanced stage, thus limiting the few therapeutic options available. The importance of this case relies in the early recognition of symptoms as in our patient who was presenting with Superior Vena Cava Syndrome and Heart Failure misdiagnosed for one year. By the time of diagnosis the patient was not candidate for tumor resection. Reference #1: Primary Cardiac Tumor: A Single-Center 41-Year Experience; Christina Maria Steger et al. International Scholarly Research Network; Vol 2012, Article ID 906109 Reference #2: Primary Intimal (Spindle Cell) Sarcoma of the Heart; A.Ibrahim et al. Hindawi Publishing Corporation; Vol 2013, Article ID 461815 Reference #3: Survival After Resection of Primary Cardiac Tumors. A 48-Year Experience; Andrew W. ElBardissi et al. CirculationAHA.107783126 DISCLOSURE: The following authors have nothing to disclose: Michael Cruz Caliz, Iván González Cancel, Ricardo Fernandez, Modesto Gonzalez-del Rosario, Kelvin Rivera Manzano, Gustavo Gonzalez Astacio, Joel Nieves Scharon, Hiram Jose Maldonado Quintana, Pedro Torrellas-Ruiz, Kimberly Padilla Rodriguez No Product/Research Disclosure Information

Primary Cardiac Tumors in Infants and Children: Surgical Strategy and Long-Term Outcome

Primary cardiac tumors in infants and children are extremely rare; hence, there is very little literature available, and most knowledge is based on collections of case reports. This report is a comprehensive review of our 26-year experience with primary cardiac tumors in children with emphasis on surgical indications, strategies, and long-term outcome. Between 1986 and 2012, 47 children (mean age 5.9 ± 2.4 months; range, 1 day to 17 years) underwent either subtotal or total resection of cardiac tumors (rhabdomyoma, 13; fibroma, 12; teratoma, 9; myxoma, 8; hemangioma, 2; rhabdomyosarcoma, 1; non-Hodgkin's lymphoma, 1; lymphangioma, 1). The majority were diagnosed by echocardiography (n= 33). Clinical patterns were varied: 40 had an atypical heart murmur and 6 were asymptomatic. Outflow tract obstruction of more than 30 mm Hg was present in 11 children. Three patients had abnormal coronary arteries secondary to pressure from tumor bulk. Indications of resection were hemodynamic/respiratory compromise, severe arrhythmia, and asignificant embolization risk. Strategy of resection varied according to location and hemodynamic status without damage to adjacent structures. Morbidity included bleeding in a patient and a transient low output state in another. A 5-month-old infant with left ventricular fibroma underwent left ventricular assist device implantation secondary to failure from weaning off cardiopulmonary bypass, and she eventually underwent heart transplantation 17 days later. Early mortality (n= 2, 4.2%) included a 5-month-old infant who underwent complete resection of rhabdomyoma located in the left ventricle, with concomitant pulmonary valve replacement; unfortunately, he underwent left ventricular assist device implantation for postoperative heart failure and died on the 13th postoperative day. An8-month-old child with 3 cm× 4 cm fibroma obstructing the right ventricular outflow tract compressing the right coronary artery died of severe right-side heart failure on the 13th postoperative day. One late death (2.1%) occurred; a 16-year-old with non-Hodgkin's lymphoma died 7 months after the surgery. Mean duration of follow-up is 11.6 ± 3.5 years. All survivors (93.4%) are well, free of tumor-related symptoms and tumor recurrence/progression, even when resection was incomplete. This study illustrates that although primary cardiac tumors in infants and children have a wide and unusual spectrum of clinical presentation, an individualized approach to tumor resection allows restoration of an adequate hemodynamic function and satisfactory long-term, tumor-free outcome.

Outcomes of multiple myxoma resections with carney complex

Introduction: Carney Complex is a rare multiple endocrine neoplasia with cardiac myxomas being the most common cause of death among affected patients. One must consider how many heart surgeries a patient may acquire before the treatment itself becomes a significant risk factor. The use of an intra-aortic filter during cardiac surgeries is recommended, and heart transplantation treatment for Carney Complex patients is proposed. Presentation of case: A 24-year-old female presented with lightheadedness and was found to have a cardiac myxoma on the left atrium. The patient underwent myxoma resections on four separate occasions. The patient underwent a fifth cardiac myxoma resection. However, three days post-operatively, the patient experienced right-sided hemiplegia and imaging showed 99% left carotid artery occlusion. The patient was deemed unqualified for neurosurgical intervention and the patient died 5 days post-operatively. Discussion: Cardiac surgery can become detrimental with multiple surgical resections. With increased number of cardiac surgeries and increased risk for morbidities postoperatively, Carney Complex patients should have an intra-aortic filter to lower the risk of stroke. Conclusions: Intra-aortic filter usage is recommended during surgical resection of cardiac tumors to capture emboli before they travel into the systemic circulation. Heart transplant may prove beneficial to Carney complex cases, however neither the optimal number of cardiac operations nor the timing of heart transplantation in the disease are documented in literature, limiting evidence for solid therapeutic guidelines.

Outcomes of video-assisted minimally invasive approach through right mini-thoracotomy for resection of benign cardiac masses; compared with median sternotomy.

We performed a retrospective study of patients who underwent a video-assisted minimally invasive right mini-thoracotomy approach for cardiac benign tumor resection compared with median sternotomy. Of 23 patients who underwent isolated benign cardiac mass resection at the Japanese Red Cross Nagoya Daiichi Hospital from 2001 to 2014, 16 patients were treated through median sternotomy and seven were operated through right mini-thoracotomy. No hospital deaths occurred. The duration of operation, cardiopulmonary bypass time, and aortic clamp time showed no significant differences. Although the postoperative intubation time and intensive care unit stay time did not differ significantly between the groups, the duration of hospital stay was significantly shorter in the minimally invasive group (17.5 ± 5.6 vs. 10.4 ± 1.5 days; p = 0.004). All of the patients except two were followed to the late phase (late follow-up rate, 91.3%), for a mean duration of 4.7 ± 3.7 years. There were two late deaths in the sternotomy group and no recurrences in either group during the follow-up period. We concluded that the clinical outcome of the minimally invasive technique for myxoma resection was acceptable and the technique is feasible.

Surgery for Primary Cardiac Tumors in Children

Background— To evaluate indications and results of surgery for primary cardiac tumors in children. Methods and Results— Eighty-nine patients aged ≤18 years undergoing surgery for cardiac tumor between 1990 and 2005 from 16 centers were included retrospectively (M/F=41/48; median age 4.3 months, range 1 day to 18 years). Sixty-three patients (68.5%) presented with symptoms. Surgery consisted of complete resection in 62 (69.7%) patients, partial resection in 21 (23.6%), and cardiac transplant in 4 (4.5%). Most frequent histotypes (93.2%) were benign (rhabdomyoma, myxoma, teratoma, fibroma, and hemangioma). Postoperative complications occurred in 29.9%. Early and late mortality were 4.5% each (mean follow-up, 6.3±4.4 years); major adverse events occurred in 28.2% of the patients; 90.7% of patients are in New York Heart Association class I. There were no statistically significant differences in survival, postoperative complications, or adverse events after complete and partial resection in benign tumors other than myxomas. Cardiac transplant was associated significantly with higher mortality rate ( P= 0.006). Overall mortality was associated to malignancy ( P =0.0008), and adverse events during follow-up ( P =0.005). Conclusions— Surgery for primary cardiac tumors in children has good early and long-term outcomes, with low recurrence rate. Rhabdomyomas are the most frequent surgical histotypes. Malignant tumors negatively affect early and late survival. Heart transplant is indicated when conservative surgery is not feasible. Lack of recurrence after partial resection of benign cardiac tumors indicates that a less risky tumor debulking is effective for a subset of histotypes such as rhabdomyomas and fibromas.

Minimally invasive strategy for resection of primary cardiac tumors: Single-center experience

Minimally invasive strategy for resection of primary cardiac tumors: Single-center experience

Invited Commentary

As the largest reported experience of cardiac tumor resection using minimally invasive techniques, this report [1Iribarne A. Easterwood R. Russo M.J. et al.Long-term outcomes with a minimally invasive approach for resection of cardiac masses.Ann Thorac Surg. 2010; 90: 1251-1256Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar] provides valuable insight into the advantages of minimally invasive surgery used in the appropriate patient and context. The sternotomy approach remains the standard of care, but the authors demonstrate that minimally invasive techniques in selected patients provide similar oncologic resection with reduced hospital length of stay. When added to the other studies cited by the authors, these data help document a reproducible benefit of nonsternotomy approaches on patient recovery. This finding is important because all surgeons are under pressure to discharge patients early regardless of the techniques they prefer. Management decisions that affect length of stay (eg, when to extubate, discharge from the intensive care unit or the hospital) are susceptible to patient and provider biases. The authors should confirm this benefit in a follow-up study by measuring other surrogates of recovery time such as the Duke Activity Status Index or by documenting the time required to return to work. Their suggestion that stroke rates may be improved by less invasive surgery is more problematic because of the poor power of the study and the presence of multiple confounders, measured and unmeasured. The minimally invasive cohort was younger and had smaller tumors isolated to the left atrium. Postoperative strokes in the sternotomy cohort occurred in those at high risk for stroke, such as complex atrial reconstructions with diffuse attachments of tumor or thrombus, chronic atrial fibrillation, and a history of stroke. Because both groups avoided the risk of complications associated with femoral and endoaortic approaches, the biologic rationale that implicates the choice of surgical incision on postoperative stroke is weak. Success with surgical innovation starts by building a multidisciplinary team. Because learning comes from doing, it is unrealistic to expect to build a team around a rare operation like the atrial tumor resection. The authors of this study benefitted from extensive experience with minimally invasive mitral valve surgery that was readily transferrable to atrial tumor resection. Although not specifically outlined in this report, it is highly likely that the fundamentals of team training were still relevant despite the benefit of the “halo effect.” Successful adoption of change centers on regular team meetings to review the goals of the cardiac tumor program and provide regular feedback of outcomes after minimally invasive resection. Adverse trends are coupled with an action plan for improvement, and favorable outcomes are promoted to reinforce the extra efforts required of front-line staff. Their final step, a peer-reviewed publication, helps to establish an infrastructure in which all the elements needed for future innovations become integrated, creating an environment where seamless change becomes second nature. Long-Term Outcomes With a Minimally Invasive Approach for Resection of Cardiac MassesThe Annals of Thoracic SurgeryVol. 90Issue 4PreviewMinimally invasive cardiac surgery has been used with increased frequency in all areas of cardiac surgery. The purpose of this study was to compare the effectiveness of a minimally invasive (MI) versus traditional sternotomy approach for the resection of cardiac masses. Full-Text PDF

Surgical experience with right ventricular tumors in 17 patients

Resection of cardiac tumors in the right ventricle sometimes requires valve plasty or replacement. We retrospectively studied surgical treatment for right ventricular tumors. The study cohort consists of 210 consecutive patients who underwent surgical treatment for a cardiac tumor in our hospital between January 1990 and December 2008. Clinical findings were reviewed retrospectively, and a follow-up study was performed. Of 210 cardiac tumors, 17 were located in the right ventricle. Of these17 right ventricular (RV) tumors, 13 were endocardial or intracavitary tumors, and 4 were epicardial tumors. Of the 17 patients, 5 underwent concomitant tricuspid valve surgery. Three of the five patients had endocardial tumors and underwent Kay annuloplasty; the other two had epicardial tumors, one of whom underwent reconstruction of the tricuspid annulus by suturing of an autologous pericardial strip, and one had tricuspid valve replacement with a 31-mm Hancock valve. Of the five patients with concomitant tricuspid valve surgery, none had an increase to grade 3 tricuspid regurgitation during follow-up. Tricuspid valve annuloplasty for resection of RV tumors may be necessary, even for palliative operations, to improve the hemodynamics.

A Case of Cerebral Embolism With Metastatic Chondrosarcoma in the Left Atrium

Cardiac tumor is a rare, but clinically important source of cerebral embolism. We report a case of metastatic chondrosarcoma in the left atrium with multiple cerebral emboli. A computed tomography scan of the chest revealed a large mass in the left atrium and pulmonary vein. The patient underwent heart surgery to remove the metastatic chondrosarcoma in the left atrium, to prevent the formation of further systemic emboli and possible sudden death. The cardiac tumor resection was successful, and the patient was discharged from the hospital without any handicap. This is a rare case of metastatic cardiac tumor that was a source of emboli into the brain and was eradicated.

Survival After Resection of Primary Cardiac Tumors

Primary cardiac tumors are rare but have the potential to cause significant morbidity if not treated in an appropriate and timely manner. To date, however, there have been no studies examining survival characteristics of patients who undergo surgical resection. From 1957 to 2006, 323 consecutive patients underwent surgical resection of primary cardiac tumors; 163 (50%) with myxomas, 83 (26%) with papillary fibroelastomas, 18 (6%) with fibromas, 12 (4%) with lipomas, 28 (9%) with other benign primary cardiac tumors, and 19 (6%) with primary malignant tumors. Operative (30 day) mortality was 2% (n=6). Univariate analysis indicated that patients who underwent resection of fibromas and myxomas had superior survival characteristics in comparison to the remainder of tumor variants; these results were consistent after adjusting for age at surgery, year of surgery, and cardiovascular risk factors. Based on actuarial characteristics of the 2002 U.S. population, patients who underwent myxoma resection had survival characteristics that were not significantly different from that of an age and gender matched population (SMR 1.11, P=0.57) whereas those who underwent resection of fibromas (SMR 11.17, P=0.002), papillary fibroelastomas (SMR 3.17, P=0.0003), lipomas (SMR 5.0, P=0.0003), other benign tumors (SMR 4.63, P=0.003), and malignant tumors (SMR 101, P<0.0001) had significantly poorer survival characteristics. Furthermore, malignant tumors in younger patients were highly fatal (HR 0.899, P<0.0001). Although the most significant predictor of mortality was tumor histology, survival was also influenced the by the duration of CPB and NYHA III/IV; the impact of these risk factors varied with time. The cumulative incidence of myxoma recurrence was 13% and occurred in a younger population (42 versus 57 years, P=0.003) with the risk of recurrence decreased after 4 years. Surgical resection of primary cardiac tumors is associated with excellent long-term survival; patients with cardiac myxomas have survival characteristics that are not significantly different from that of a general population. Predictors of mortality are primarily related to tumor histology but also include clinical characteristics such as symptomatology and duration of CPB.

Intracardiac, mediastinal and CNS metastases in pediatric osteosarcoma: extending survival

10036 Background: Extrapulmonary osteosarcoma (OS) metastases portend poor outcome and short survival. Local control is essential for durable remission. Intracardiac, mediastinal and CNS metastases are ominous: many oncologists cease therapy when they occur. We present a series of 19 patients with relapse in poor-prognosis locations, and focus on one patient in 3rd relapse of OS in whom widespread disease, including intraventricular and CNS metastases, was controlled with chemotherapy, radiotherapy, novel agents, cardiac tumor resection and neurosurgery. Methods: Imaging included CT, PET-CT, bone scan, echocardiogram, and MRI. Systemic therapy included liposomal doxorubicin (D), bevacizumab (A), rapamycin (R), cisplatin (C), valproic acid (V), and zoledronic acid (ZA). Other patients received ifosfamide, samarium with gemcitabine, cyclophosphamide, temezolomide, and L-MTP-PE. Local control included surgery for cardiac and mediastinal metastasis and XRT or surgery for CNS metastasis. Results: D+A caused tumor shrinkage. The patient received XRT to 9 sites over 4 courses with C (q 2 wk), R (daily), V (daily) or ZA (q 4 wk) for radiosensitization. PET-CT after 8 weeks showed metabolic resolution of most lesions, regardless of XRT. Echocardiogram identified 2 LV cardiac metastases, which were resected without complication. A left parietal mass was resected with no complication and normal neurologic exam post-surgery. The patient is doing well on treatment 11 months after relapse, with few sites of active disease and good quality of life. The majority of patients had reduced tumor burden and objective responses on PET-CT. Good post-operative quality of life was achieved after resection of cardiac (1), mediastinal (5) or CNS (2) metastases. XRT with chemotherapy was used for 6 mediastinal and 5 skull/CNS patients. 2/12 mediastinal and 0/7 CNS patients had developed recurrent disease in these sites. Conclusions: Novel agents were well-tolerated and effective, enabling aggressive local control in difficult-to- treat locations. PET-CT gave an earlier and more accurate measure of response than CT alone. Resection of cardiac, mediastinal and CNS metastases in pediatric patients is feasible and can be well-tolerated, prolonging survival and improving quality of life. No significant financial relationships to disclose.

Analysis of benign ventricular tumors: Long-term outcome after resection

We sought to compare clinical and pathologic characteristics of ventricular tumors and to detect whether differences exist in short- and long-term survival after resection. From 1964 to 2005, 323 patients had cardiac surgery for resection of primary cardiac tumors; 53 (16%) patients had primary ventricular tumors. We randomly sampled 53 characteristics of ventricular tumors. Patients with ventricular tumors were younger than those with atrial tumors (34.8 vs 54.6 years; P < .0001). New York Heart Association functional status was similar at presentation, although patients with atrial tumors had increased risk of atrial fibrillation (P < .05), thromboembolic events (P = .04), and mitral stenosis (P = .008) at the time of presentation. Patients with ventricular tumors had an increased incidence of myocardial invasion (14% vs 2%; P = .02) and had significantly longer cardiopulmonary bypass (80 vs 65 minutes; P < .05) and crossclamp (52 vs 39 minutes; P = .03) times. Operative mortality was 4% and 0% in the ventricular and atrial groups, respectively (P = not significant). Follow-up was obtained in 89% of patients at a mean follow-up time of 7.21 years. A Kaplan-Meier survival plot demonstrated no difference in survival characteristics of both groups. At follow-up, 81% and 74% of ventricular and atrial tumors, respectively, were minimally symptomatic (New York Heart Association class I/II; P = .13). Patients with atrial and ventricular tumors had a 6% and 0% tumor recurrence rate, respectively (P = .12). Surgical resection for ventricular tumors is effective and results in excellent long-term outcome. Early surgical treatment should be strongly considered in patients with primary ventricular tumors.