Intracardiac Tumor Research Articles

Cardiac Myxoma Resection in Sanglah General Hospital Denpasar, Indonesia: Serial Case Report

Background: Cardiac myxoma is a primary tumor that grows intracardiac. Primary heart tumors are rare, and incidents range from 0.0017 to 0.03%. Around 75% of primary heart tumors are benign, and 50-80% are cardiac myxoma. Echocardiography is the gold standard in detecting tumor mass in the heart. With the development of diagnostic modalities and cardiac surgery techniques, cardiac myxoma can be detected and treated correctly and leading to a better prognosis.Objective: To report a series of cases of cardiac myxoma resection carried out by the Cardiac Surgery team of Sanglah General Hospital Denpasar.Cases: Data collected from 2016 to March 2019 cased based on Sanglah General Hospital Denpasar. Six cases were diagnosed based on the clinical, electrocardiographic, radiological, and histopathological basis.Conclusion: This series of cases reported six intracardiac tumor patients who were found through echocardiographic examination and five patients had open heart surgery for tumor resection; also all histopathological examination results were following cardiac myxoma. There were no reported post-treatment complications and the patients were discharged hemodynamically stable after hospitalized for approximately one week. Until now, there have been no reports of recurrence in patients who have taken resection and patients have normal daily life activities.

P01-T EEG recordings usefulness on clinically asymptomatic newborns with tuberous

Background A 39-week (GA) female, with no relevant family history or parental consanguinity, with a fetal ultrasonographic image of an intracardiac tumor. Physical examination was unremarkable. Magnetic-resonance-imaging (MRI) showed subependymal nodules and cortical tubers. Methods and results Eight channel video-EEG was performed four times. 1. EEG recorded within nine days following birth was asymmetric with excessive slow activity over the left hemisphere and isolated sharp waves over the left-central region. Seven rhythmic trains of theta activity evolving to a higher voltage delta and intermixed sharp waves showed left-sided preponderance. Duration ranged from 5–60 s with no obvious clinical correlation. Amplitude-integrated EEG showed persistent electrical seizures over the left hemisphere. Thus antiepileptic drug treatment was indicated. 2. EEG recorded age-30-days showed asymmetry persistence and decrease in subclinical seizure burden (2). 3. EEG recorded age-58-days was again asymmetric, some isolated and pseudoperiodic (1–1.5 Hz) sharp waves over the left- central region, and three subclinical seizures (1–1.5-min duration). 4. EEG recorded at four months of age (wake and sleep stages) showed 4 Hz posterior rhythm in both hemispheres, bilateral sleep spindles. There was slight anterior asymmetry but no seizures. Conclusion Neonatal-onset seizures in TSC patients are infrequent, usually starting at the age of 3rd-5th months. Although EEG recording is not often used as a diagnosis tool, as there may be patients presenting with clinically silent seizures, we encourage the use of video- EEG monitoring. To find seizures in the second week of life was a surprise, but allowed early control of seizures.

Intracardiac echocardiography-guided cardiac tumor biopsy: report of the first Slovenian case

Intracardiac echocardiography-guided cardiac tumor biopsy: report of the first Slovenian case

Evaluation of the potential predictors of embolism in patients with left atrial myxoma.

Cardiac myxomas are the most common primary intracardiac tumors. Although myxomas are histologically benign, they are potentially dangerous due to potential risk of systemic and cerebral embolism. In this study, we aimed to investigate the potential predictors of embolism in patients with left atrial myxoma. This single-center retrospective study enrolled 93 patients (mean age: 52.9±15.3years, female: 70 [75.3%]) with left atrial myxomas between 2014 and 2018. The patients were classified into two groups (embolic vs nonembolic) to investigate possible predictors of embolism. Demographic, laboratory, and echocardiographic parameters were recorded into a dataset and compared between patients with and without embolism. The study population was composed of 13 (14%) patients in embolic (11 cerebrovascular and 2 peripheral) and 80 (86%) patients in nonembolic group. Demographic and laboratory parameters were similar between the groups. Tumor sizes were significantly higher in the embolic group than in the nonembolic group (5.59±1.08 vs 4.29±0.61; P=0.001). By multivariate analysis, increased tumor size, increased left atrial diameter, and the presence of atrial fibrillation and irregular tumor surface were identified as independent predictors of embolism. In ROC curve analyses, tumor size above 4.6cm predicted embolism with a sensitivity of 77% and a specificity of 73% (AUC: 0.858; 95% CI: 0.752-0.964; P<0.001). The presence of atrial fibrillation, irregular tumor surface, increased tumor size, and increased left atrial diameter is associated with increased risk of embolism in patients with left atrial myxoma. Early surgery should be scheduled for such patients due to increased potential for embolism.

CALCIFYING PSEUDOTUMOR: ECHOCARDIOGRAPHIC FINDINGS FOR CLINICAL DECISION MAKING

It is important to determine optimal treatment methods of rare intracardiac tumor with different strategies of management, including whether cardiac surgery is necessary, the selection of surgical methods and surgical timing. Echocardiography would be helpful for clinical decision-making of

Diagnosis and treatment complications of primary cardiac lymphoma in an immunocompetent 28-year old man: a case report

BackgroundPrimary cardiac lymphomas (PCL) represent extremely rare cardiac tumors which are accompanied by poor prognosis, unless they are timely diagnosed and treated.Case presentationHerein we present a 28-year-old, immunocompetent man who presented to our hospital due to progressively worsening symptoms and signs of superior vena cava syndrome. Multi-modality imaging demonstrated a large intracardiac tumor, which was proven, by biopsy, to be a PCL. The patient received targeted chemotherapy which led to total remission of his disease, with no relapse over a 15-month follow-up period.ConclusionsAlthough PCLs are rare, they should always be kept in mind in the differential diagnosis of cardiac tumors. Timely diagnosis of PCLs and appropriate chemotherapy, alone or in combination with radiotherapy, seems to provide the best results.

Is there an association of intracardiac mass with high urate level? AIM-HUL study

Context: Hyperuricemia is associated with idiopathic left atrium/left ventricular clot, and its association with other intracardiac tumors is not clear. Aim: The study aimed to establish if there is an association of intracardiac mass with high urate level. Settings and Design: This prospective study included 440 individuals, of which 330 were consecutive all comers with intracardiac mass detected on echocardiography from June 2016 to December 2017, who were compared with 110 randomly selected healthy controls undergoing echocardiography during the same without intracardiac mass in a ratio of 3:1. Materials and Methods: Imaging modalities such as transesophageal echocardiography, cardiac computerized tomography, and/or cardiac magnetic resonance imaging were done to analyze the intracardiac mass. Both the groups were analyzed for serum uric acid (SUA) levels at the time of detection of intracardiac mass. Statistical Analysis Used: Univariate analysis was done for continuous variables using Student's t-test, whereas the Chi-square test was used for the categorical data. Logistic regression analysis was performed with the presence of a mass with SUA as the dependent variable. Results: Among a total of 440 patients, 330 were cases and 110 were controls with the mean age of 47.52 ± 16.02 years (18–77 years) versus 45.23 ± 14.10 (18–73 years) years with male:female ratio of nearly 3:2 in both the groups. Mean SUA in cases was significantly higher than controls (7.60 ± 0.93 vs. 4.52 ± 1.20 mg%) (P

Cardiac metastasis of rectal cancer diagnosed by intracardiac echocardiography-guided tumor biopsy and treated by surgical resection

Cardiac metastasis of rectal cancer diagnosed by intracardiac echocardiography-guided tumor biopsy and treated by surgical resection

Tumour Emboli Causing Multifocal Ischemic Stroke from Intracardiac Malignant Solitary Fibrous Tumour

A 78-year-old woman presented to the emergency department with gait ataxia and diplopia. Her past medical history included the surgical resection of a phyllodes breast tumour 8 years prior, with no known recurrence. A computed tomography (CT) scan of the brain demonstrated multifocal right supratentorial hemispheric subacute infarcts in the frontoparietal, posterior temporal and occipital regions. The patient developed recurrent generalized seizures in hospital. Transesophageal echocardiogram demonstrated a large 2.7 × 1.8 × 0.8 cm mobile echogenic mass attached to the left posterior atrial wall. CT angiogram of the chest revealed the left atrial mass as well as a mass encasing the right bronchus intermedius. The patient opted for comfort care and passed away in hospital. Autopsy revealed the tumour to be a primary cardiac solitary fibrous tumour. We present a case of multifocal ischemic stroke and seizures secondary to tumor emboli originating from intracardiac solitary fibrous tumour.

Cardiac Myxoma- 17 Years Experience in a Tertiary Care Centre of Bangladesh

Cardiac Myxoma is the most common benign intracardiac tumor of heart. We studied its incidence, clinical presentations, short term outcome, morbidity and mortality following surgery over a period of 17 years. The study was performed inthe department of cardiac surgery, National institute of Cadiovascular diseases (NICVD) Dhaka, over a period from 2000to 2016. NICVD is the tertiary hospital for cardiovascular surgery in the Government sector. Over this period of 17 years 11,923 open heart surgery was done of which 129 were cardiac myxoma patients. As a result, cardiac myxoma patients constituted 1.08%of all open heart surgery. Preoperative diagnosis was done on clinical presentations and 2D echocardiography, which is the most important tool for its diagnosis. Most of the patients presented at 4th to 5th decade of life. The patients presented with triad ofvalve obstructive features, embolic symptoms andconstitutional symptoms alone or in combination. Among all myxoma patients, majority(86.6%) had left atrial myxoma. Cardiac myxoma forms a very small percentage of all cardiac diseases requiring surgical treatment. Immediate surgical excision is indicated in all patients to avoid life-threatening complications. Outcome of surgical treatment was excellent.Bangladesh Heart Journal 2017; 32(2) : 85-88

Abstract 123: Diagnostic Yield of TEE in Patients With Cryptogenic Stroke and TIA With Normal TTE: A Systematic Review and Meta-Analysis

Background: The diagnostic utility of Transesophageal echocardiography (TEE) in cryptogenic stroke or TIA remains controversial. Objective: To perform a systematic review and meta-analysis to estimate an additional diagnostic yield and clinical impact of TEE in patients with cryptogenic stroke and TIA with normal Transthoracic Echocardiography (TTE) results. Methods: A PubMed literature review was performed of cohort studies. The studies were excluded if routine stroke work-up was not documented, TTE was not performed on all patients or clear TTE data not available, separate analysis for patients with normal TTE results were not available, did not report all cardiac TEE findings, and included patients with Afib or did not have a separate analysis for patients without Afib. Results: Fifteen studies met the criteria, with total of 2054 patients with cryptogenic stroke or TIA with normal TTE results and underwent TEE. All studies were evaluated for internal validity and indirectness. Following TEE findings were noted across different studies: LA/LAA/Aortic thrombus, valvular vegetation, intracardiac tumor, spontaneous echo contrast, PFO, ASA, PFO -ASA combination, valvular abnormalities and complex aortic plaques. 37.5% (29.7% - 45.1%) of patients had additional cardiac findings on TEE. PFO was the second most common abnormality noted after complex aortic plaque. 13.6% (8.1% - 19.1%) of patients required changes in the management after TEE evaluation. Based on the current guidelines, it should change management in 4.1% (2.1% - 6.2%) of patients. It could potentially change management in 30.4% (21.9% - 38.9%) of patients. Analysis was also performed with only class II studies to increase internal validity, which showed additional cardiac findings in 38.4% (28.5% - 48.3%), changed management in 20.2 % (8.7% - 31.8%), should change management in 4.7% (1.5% - 7.9%) and could potentially change management in 30.4% (17.8% - 43.0%) of patients. Conclusions: The diagnostic yield of TEE to find any additional cardiac findings in patients with cryptogenic stroke or TIA is approximately 38%. Based on this analysis, number needed to diagnose one additional abnormality with TEE that can change management per current guidelines is approximately 21.

What is Clinical Efficacy of Transesophageal Echocardiography in Patients With Cryptogenic Stroke?: A Critically Appraised Topic.

Adults with cryptogenic stroke often undergo transesophageal echocardiogram (TEE) because this is the gold-standard for evaluation of potential proximal sources of emboli. The risks of performing this invasive test must be weighed against its clinical efficacy and limitations, determined by the rate of positive findings, and the impact on clinical outcome for the patient. To critically appraise current evidence regarding the rate of positive TEE findings in cryptogenic stroke patients, and analyze the implications of these findings on management decisions and outcomes. The objective was addressed through the development of a structured, critically appraised topic. We incorporated a clinical scenario, background information, a structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, and vascular neurology and cardiology content experts. TEE commonly identifies abnormalities, including aorta atherosclerosis in 51%, patent foramen ovale in 43%, and atrial septal aneurysm in 13% of patients. Findings such as left-sided chamber thrombus or intracardiac tumor that definitively warrant a change in management by guideline-supported use of anticoagulation are less common, occurring in ∼3% of patients. TEE identifies potential causal sources of embolus in patients with cryptogenic stroke that leads to changes in management and outcomes at least 3% of the time. Other findings, particularly aorta atherosclerosis, are identified much more commonly but the causal link to stroke is uncertain, thus changes in management in these cases is variable and data describing resulting outcomes are lacking.

Acute myocardial infarction and coronary embolism: Mechanisms and management

Coronary artery embolism (CE) is recognized as an important non-atherosclerotic cause of acute myocardial infarction. Its prevalence, clinical features, and prognosis remain unclear. We studied 1232 consecutive patients who presented with de novo acute myocardial infarction between 2006 and 2015. CE was diagnosed based on criteria encompassing clinical, angiographic, and other imaging findings including intravascular imaging. The prevalence of CE was 4.3% ( n = 53), including 12 patients (22.6% of cases) with multivessel CE. In comparison with the non-CE group, age and coronary risks factors except smoking ( P = 0.03) were not significantly different in the CE group. PCI procedures was characterized by a distal coronary occlusion in 33 patients (62.2%), a more frequent GP2b3a inhibitors use (62.2% vs. 37.7%, P < 0.001) but lower angioplasty requiring balloon and/or stent rate in CE group (54.7% vs. 45.2%, P < 0.001). CE group was characterized by a lower ST segment resolution post-MI and worse postprocedural TIMI flow grade but no significant difference in left ventricular ejection fraction were seen between the two groups. The most frequent underlying disease was atrial fibrillation ( n = 15, 28.3% of cases) followed by intracardiac tumor ( n = 3) and endocarditis ( n = 4) whereas malignancy and antiphospholipid syndrome represented two major cause of hypercoagulable state ( n = 15) leading also to CE. However, 14 patients (26% of cases) had no identified cause of CE. During a median follow-up of 54 months, no CE and thromboembolism was noted. Kaplan-Meier curves of event free survival (all-cause death and recurrent myocardial infarction) showed that CE group had a poorer prognosis (Log-rank test P < 0.004) mainly influenced by neoplasia and endocarditis ( Fig. 1 ). Patients with CE represent a high-risk subgroup of patients and their prognosis is mainly influenced by underlying cause.

Coronary Embolism Among ST-Segment-Elevation Myocardial Infarction Patients: Mechanisms and Management.

Coronary artery embolism (CE) is recognized as an important nonatherosclerotic cause of ST-segment-elevation myocardial infarction. The objective was to describe clinical characteristics and long-term outcomes and to identify risks factors of CE in a large consecutive series of ST-segment-elevation myocardial infarction patients. We studied 1232 consecutive patients who presented with de novo ST-segment-elevation myocardial infarction. CE was diagnosed based on criteria encompassing clinical, angiographic, and diagnostic imaging findings. A total of 53 patients were identified in the CE group including 12 (22.6%) patients with multisites CE and 9 patients with other extracoronary localization. Compared with the non-CE group, age and coronary risks factors were not significantly different in the CE group except for smoking (P=0.03) and body mass index (P<0.001). Interventional coronary procedures were characterized by a higher use of glycoprotein IIb/IIIa inhibitors (P<0.001) and lower use of angioplasty (P<0.001) in the CE group. The most frequent underlying cardiac diseases were atrial fibrillation (n=15, 28.3%) followed by dilated cardiomyopathy (n=5), endocarditis (n=4), and intracardiac tumor (n=3), whereas among systemic diseases, malignancy (n=8) and systemic autoimmune disease or antiphospholipid syndrome (n=4) were present. No etiopathological mechanisms could be identified in 14 patients (26.4%). Coronary embolism was associated with a higher risk of death (crude hazard ratio, 4.87; 95% confidence interval, 2.52-9.39; P<0.0001). Etiopathogenesis of ST-segment-elevation myocardial infarction secondary to CE is diverse ranging from cardiac to systemic disease, and patient long-term survival is worse than expected according to the baseline cardiovascular risk.

Aphthous ulcer drug inhibits prostate tumor metastasis by targeting IKKɛ/TBK1/NF-κB signaling.

Tumor metastasis is the major cause of death for prostate cancer (PCa) patients. However, the treatment options for metastatic PCa are very limited. Epithelial-mesenchymal transition (EMT) has been reported to be an indispensable step for tumor metastasis and is suggested to associate with acquisition of cancer stem cell (CSC) attributes. We propose that small-molecule compounds that can reverse EMT or induce mesenchymal-epithelial transition (MET) of PCa cells may serve as drug candidates for anti-metastasis therapy.Methods: The promoters of CDH1 and VIM genes were sub-cloned to drive the expression of firefly and renilla luciferase reporter in a lentiviral vector. Mesenchymal-like PCa cells were infected with the luciferase reporter lentivirus and subjected to drug screening from a 1274 approved small-molecule drug library for the identification of agents to reverse EMT. The dosage-dependent effect of candidate compounds was confirmed by luciferase reporter assay and immunoblotting. Wound-healing assay, sphere formation, transwell migration assay, and in vivo intracardiac and orthotopic tumor xenograft experiments were used to evaluate the mobility, metastasis and tumor initiating capacity of PCa cells upon treatment. Possible downstream signaling pathways affected by the candidate compound treatment were analyzed by RNA sequencing and immunoblotting.Results: Drug screening identified Amlexanox, a drug used for recurrent aphthous ulcers, as a strong agent to reverse EMT. Amlexanox induced significant suppression of cell mobility, invasion, serial sphere formation and in vivo metastasis and tumor initiating capacity of PCa cells. Amlexanox treatment led to downregulation of the IKK-ɛ/ TBK1/ NF-κB signaling pathway. The effect of Amlexanox on EMT reversion and cell mobility inhibition can be mimicked by other IKK-ɛ/TBK1 inhibitors and rescued by reconstitution of dominant active NF-κB.Conclusions: Amlexanox can sufficiently suppress PCa metastasis by reversing EMT through downregulating the IKK-ɛ/TBK1/NF-κB signaling axis.

Intra-cardiac extension of a Wilms’ tumor

Wilms᾿ tumor, or renal nephroblastoma, is the commonest malignant renal tumor in children and young adults. Intravascular and intracardiac extension of this tumor is a very rare and challenging clinical entity. The case is reported of a 6-year-old boy diagnosed with nephroblastoma, in whom the tumor involved the inferior vena cava and the right atrium. The successful multimodal surgical management consisted of combined, synchronous surgical resection of both renal and intracardiac tumors. The boy had an uneventful postoperative course and recovery, followed by relapse-free living. Intra-cardiac extension of Wilm’s tumor poses a surgical challenge where the favorable outcome is provided only by the combined and well-coordinated, skilled multidisciplinary care of pediatric surgeons and pediatric cardiac surgeons.

Outcomes following embolization in patients with cardiac myxoma

Cardiac myxomas are the most frequent primary benign intracardiac tumors. We reviewed our 27-year experience to evaluate factors associated with an embolism in patients with cardiac myxomas and their long-term outcomes. A retrospective review identified 99 patients with cardiac myxomas between 1985 and 2012. Tumors were divided into two groups based on their gross external features. Tumors with a smooth regular border and a solid consistency were classified as solid; papillary myxomas were characterized by an irregular and gelatinous exterior with friable, soft consistency. The patients were classified into embolic and non-embolic groups to focus on embolic events. Mean age at surgery was 49.8 ± 16 years. There were 92 left atrial myxomas (92.9%). Embolization was observed in 25 patients (25.3%) before surgery. Three variables were associated with an embolic event, small tumor size (odds ratio [OR] = 4.36 P = 0.037 confidence interval [CI] 95% 0.534-0.980), atrial fibrillation (OR = 10.119 P = 0.001 CI 95% 0.021-0.397), and papillary-type pathology (OR = 11.544 P = 0.001 CI 95% 0.033-0.399). Tumor pathology or the presence of embolization prior to surgery had no effect on operative mortality or long-term survival. Embolization of cardiac myxomas is more likely to occur in papillary-type tumors, that are smaller in size and in patients presenting with preoperative atrial fibrillation. However, the presence of embolization at the time of surgery does not increase operative morbidity or mortality or affect long-term survival.

Mechanical thrombectomy for repeated cerebral tumor embolism from a thoracic sarcomatoid carcinoma

Cerebral embolism originating from intracardiac tumors represents a rare cause of stroke and has been documented in both adult and pediatric populations. We present a patient recently diagnosed with a...

Atypical size and location of a right atrial myxoma: a case report

Primary intracardiac tumors are rare and approximately 50-55% are myxomas. The majority of myxomas are located in the left atrium. Here We report a case of a large myxoma in the right atrium, which is an uncommon location for this type of tumor who underwent operative intervention with excision of a 9x6 cm multilobulated mass. In this case report, we emphasize the rarity of large myxomas in the right atrium and the difficulty of differential diagnosis given their dimension and location.

Atypical clinical presentation of right atrial myxoma: a case report

Primary intracardiac tumors are rare and approximately 50% are myxomas. Majority of myxomas are located in left atrium. Most of myxomas are attached to inter-atrial septum and have variable clinical presentation depending on size, location and mobility of the tumor. We report a case of large myxoma in the right atrium with atypical clinical presentation and location for this type of tumor.