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Asif M, Yousuf MH, Farooqui US, Nashwan AJ, Ullah I. Cutaneous signs of selected cardiovascular disorders: A narrative review. Open Med (Wars) 2024; 19:20240897. [PMID: 38463529 PMCID: PMC10921438 DOI: 10.1515/med-2024-0897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 03/12/2024] Open
Abstract
Cardiovascular diseases are the leading cause of mortality and morbidity globally. Clinicians must know cutaneous signs of cardiovascular disease, including petechiae, macules, purpura, lentigines, and rashes. Although cutaneous manifestations of diseases like infectious endocarditis and acute rheumatic fever are well established, there is an indispensable need to evaluate other important cardiovascular diseases accompanied by cutaneous signs. Moreover, discussing the latest management strategies in this regard is equally imperative. This review discusses distinctive skin findings that help narrow the diagnosis of cardiovascular diseases and recommendations on appropriate treatment.
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Affiliation(s)
- Marium Asif
- Faculty of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | | | - Irfan Ullah
- Department of Internal Medicine, Khyber Teaching Hospital, Kabir Medical College, Gandhara University, Peshawar, Pakistan
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Oktaviono YH, Saputra PBT, Arnindita JN, Afgriyuspita LS, Kurniawan RB, Pasahari D, Milla C, Wungu CDK, Susilo H, Multazam CECZ, Alkaff FF. Clinical characteristics and surgical outcomes of cardiac myxoma: A meta-analysis of worldwide experience. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107940. [PMID: 38219702 DOI: 10.1016/j.ejso.2023.107940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024]
Abstract
Cardiac myxoma is the most common primary cardiac tumor. However, existing literature mainly consists of single-center experiences with limited subjects. This systematic review aimed to provide data on clinical characteristics and surgical outcomes of cardiac myxoma. We performed a thorough literature search on May 23, 2023 on PubMed, ProQuest, ScienceDirect, Scopus, and Web of Science. The inclusion criteria were English full-text, observational studies, and included >20 subjects. From the search, 112 studies with a total of 8150 patients were included in the analysis. The mean age was 51 years (95 % confidence interval [95%CI] = 49.1-52.3), and the majority were females (64.3 % [95 % CI = 62.8-65.8 %]). The most common clinical manifestation was cardiovascular symptoms. Echocardiography can diagnose almost all cases (98.1 % [95 % CI = 95.8-99.6 %]). Cardiac myxoma was mostly prevalent in left atrium (85.3 % [95%CI = 83.3-87 %]) and predominantly with pedunculated morphology (75.6 % [95%CI = 64.1-84.3 %]). Post-tumor excision outcomes were excellent, with an early mortality of 1.27 % (95 % CI = 0.8-1.8 %), late mortality rate of 4.7 (95 % CI = 2.5-7.4) per 1000 person-years, and recurrence rate at 0.5 (95 % CI = 0.0-1.1) per 1000 person-years. Tumor excision is warranted in a timely manner once the cardiac myxoma diagnosis is established.
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Affiliation(s)
- Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - General Academic Hospital Dr. Soetomo, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia.
| | - Pandit Bagus Tri Saputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - General Academic Hospital Dr. Soetomo, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia.
| | - Jannatin Nisa Arnindita
- Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia; Faculty of Medicine, Universitas Airlangga, Indonesia
| | | | | | - Diar Pasahari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - General Academic Hospital Dr. Soetomo, Surabaya, Indonesia
| | - Clonia Milla
- Faculty of Medicine, Universitas Airlangga, Indonesia
| | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Hendri Susilo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Universitas Airlangga Hospital, Surabaya, East Java, Indonesia
| | | | - Firas Farisi Alkaff
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, Netherlands; Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
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3
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Pan S, Wang Y, Gu Y, Li W, Xu H. Excision of left atrial myxoma under perfused ventricular fibrillation with hypothermia after coronary artery bypass grafting. J Cardiothorac Surg 2023; 18:277. [PMID: 37817215 PMCID: PMC10563250 DOI: 10.1186/s13019-023-02400-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 09/30/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Redo heart surgery has become increasingly common but involves additional high surgical risk, especially redo surgery after coronary artery bypass grafting (CABG). CASE PRESENTATION In this study, we report the case of a 57-year-old Chinese male with left atrium myxoma who had previously undergone CABG. Common surgical methods usually include aortic cross-clamping, administering cold cardioplegia perfusion to protect the myocardium, opening the heart, and then removing the tumor. However, for patients with previous CABG, redo thoracotomy and ascending aortic cross-clamping present a greater risk of damage to the grafted vessels. In this study, we chose a right lateral mini-thoracotomy incision and hypothermia-induced ventricular fibrillation to minimize damage and avoid any adverse effects on the bridge vasculature. The patient recovered uneventfully and was discharged seven days after surgery. CONCLUSIONS For patients with previous CABG, minimally invasive right thoracotomy under perfused ventricular fibrillation with hypothermia is safe and reliable and can prevent potential damage to the ascending aorta and graft.
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Affiliation(s)
- Shaobo Pan
- Department of Operation Room, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yalin Wang
- Department of Operation Room, School of Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yanjia Gu
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Number 79 Qingchun Road, Hangzhou, China
| | - Weidong Li
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Number 79 Qingchun Road, Hangzhou, China
| | - Hongfei Xu
- Department of Cardiovascular Surgery, School of Medicine, The First Affiliated Hospital of Zhejiang University, Number 79 Qingchun Road, Hangzhou, China.
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Aluthman U, Ashour MA, Bafageeh SW, Chandrakumaran A, Alrehaili TS, Abdulrahman OA, Elmahrouk AF, Alaamri S, AlGhamdi SA, Jamjoom AA. Minimally-invasive approach via percutaneous femoral cannulation for the resection of intra-cardiac masses: a single center experience in the Middle-East. J Cardiothorac Surg 2023; 18:203. [PMID: 37400815 DOI: 10.1186/s13019-023-02295-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/25/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Intra-cardiac masses are rare and challenging lesions with an overall incidence ranging of 0.02-0.2%. Minimally invasive approaches have been recently introduced for surgical resection of these lesions. Here, we evaluated our early experience using minimally invasive techniques in addressing intra-cardiac lesions. METHODOLOGY This is a retrospective descriptive study conducted between April 2018 to December 2020. All patients were diagnosed with cardiac tumors and treated via a right mini-thoracotomy with cardiopulmonary bypass through femoral cannulation at King Faisal Specialist Hospital and Research Centre, Jeddah. RESULTS Myxoma was the most common pathology representing 46% of cases followed by thrombus (27%), leiomyoma (9%), lipoma (9%) and angiosarcoma (9%). All tumors were resected with negative margins. One patient was converted to open sternotomy. Tumor locations were in the right atrium, left atrium, and left ventricle in 5, 3, and 3 patients, respectively. The median ICU stay was 1.33 days. The median length of hospitalization was 5.7 days. There was no 30-days hospital mortality recorded in this cohort. CONCLUSION Our early experience shows that minimally invasive resection can be performed safely and effectively for intra-cardiac masses. The minimally invasive approach using a mini-thoracotomy with percutaneous femoral cannulation can be an effective alternative in resecting intra-cardiac masses that achieves clear margin resection, quick post-operative recovery, and low rates of recurrence for benign lesions.
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Affiliation(s)
- Uthman Aluthman
- Cardiovascular Department, King Faisal Specialist Hospital and Research Centre, Ar Rawdah, 2865, Jeddah, 23431, Saudi Arabia.
| | - Mohammed A Ashour
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Salman W Bafageeh
- College of Medicine, King Saud Bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia
| | | | | | | | - Ahmed F Elmahrouk
- Cardiovascular Department, King Faisal Specialist Hospital and Research Centre, Ar Rawdah, 2865, Jeddah, 23431, Saudi Arabia
| | - Shalan Alaamri
- College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | | | - Ahmed A Jamjoom
- Cardiovascular Department, King Faisal Specialist Hospital and Research Centre, Ar Rawdah, 2865, Jeddah, 23431, Saudi Arabia
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Gaisendrees C, Schlachtenberger G, Walter S, Gerfer S, Djordjevic I, Krasivskyi I, Cagman B, Weber C, Jaeger D, Kosmopoulos M, Luehr M, Mader N, Wahlers T. Long-term outcomes after minimal right lateral thoracotomy for the resection of cardiac tumors. Surg Oncol 2023; 49:101952. [PMID: 37285759 DOI: 10.1016/j.suronc.2023.101952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/15/2023] [Accepted: 05/15/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Cardiac tumors are a rare and heterogeneous entity, with a cumulative incidence of up to 0.02%. This study aimed to investigate one of the largest patient cohorts for long-term outcomes after minimally-invasive cardiac surgery using right-anterior thoracotomy and femoral cardiopulmonary bypass (CPB) cannulation. METHODS Between 2009 and 2021, patients who underwent minimally-invasive cardiac tumor removal at our department were included. The diagnosis was confirmed postoperatively by (immune-) histopathological analysis. Preoperative baseline characteristics, intraoperative data, and long-term survival were analyzed. RESULTS Between 2009 and 2021, 183 consecutive patients underwent surgery for a cardiac tumor at our department. Of these, n = 74 (40%) were operated on using a minimally-invasive approach. The majority, n = 73 (98.6%), had a benign cardiac tumor, and 1 (1.4%) had a malignant cardiac tumor. The mean age was 60 ± 14 years, and n = 45 (61%) of patients were female. The largest group of tumors was myxoma (n = 62; 84%). Tumors were predominantly located in the left atrium in 89% (n = 66). CPB-time was 97 ± 36min and aortic cross-clamp time 43 ± 24 min s. The mean hospital stay was 9.7 ± 4.5 days. The perioperative mortality was 0%, and all-cause mortality after ten years was 4.1%. CONCLUSION Minimally-invasive tumor excision is feasible and safe, predominantly in benign cardiac tumors, even in combination with concurrent procedures. Patients who require cardiac tumor removal should be evaluated for minimally-invasive cardiac surgery at a specialized center, as it is highly effective and associated with good long-term survival.
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Affiliation(s)
- Christopher Gaisendrees
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany.
| | - Georg Schlachtenberger
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Sebastian Walter
- University Hospital Cologne, Department of Orthopaedics, Cologne, Germany
| | - Stephen Gerfer
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Ilija Djordjevic
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Ihor Krasivskyi
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Burak Cagman
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Carolyn Weber
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Deborah Jaeger
- Emergency Department, University Hospital of Nancy, Nancy, France
| | - Marinos Kosmopoulos
- Center for Resuscitation Medicine, University of Minnesota, Minneapolis, USA
| | - Maximilian Luehr
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Navid Mader
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Thorsten Wahlers
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
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Van Praet KM, Kofler M, Wilkens K, Sündermann SH, Meyer A, Hommel M, Jacobs S, Falk V, Kempfert J. Minimally Invasive Extirpation of Benign Atrial Cardiac Tumors: Clinical Follow-Up and Survival. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023:15569845231170000. [PMID: 37144727 DOI: 10.1177/15569845231170000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Evidence determining the optimal treatment for cardiac tumors is rare. We report our midterm clinical outcome and patient characteristics of our series undergoing atrial tumor removal through a right lateral minithoracotomy (RLMT). METHODS From 2015 to 2021, 51 patients underwent RLMT for atrial tumor extirpation. Patients receiving concomitant atrioventricular valvular, cryoablation, and/or patent foramen ovale closure surgery were included. Follow-up was performed using standardized questionnaires (mean: 1,041 ± 666 days). Follow-up involved any tumor recurrence, clinical symptoms, and any recurrent arterial embolization. Survival analysis was successfully achieved in all patients. RESULTS Successful surgical resection was achieved in all patients. Mean cardiopulmonary bypass and cross-clamping times were 75 ± 36 and 41 ± 22 min, respectively. The most common tumor location was the left atrium (n = 42, 82.4%). Mean ventilation time was 12.74 ± 17.23 h, intensive care unit stay ranged from 1 to 1.9 days (median: 1 day). Nineteen patients (37.3%) received concomitant surgery. Histopathological analysis showed 38 myxoma (74.5%), 9 papillary fibroelastoma (17.6%), and 4 thrombus (7.8%). Thirty-day mortality was observed in 1 case (2%). One patient (2%) suffered a stroke postoperatively. No patient had a relapse of cardiac tumor. Three patients (9.7%) showed arterial embolization during follow-up. Thirteen follow-up patients (25.5%) were in New York Heart Association class ≤II. Overall survival was 90.2% at 2 years. CONCLUSIONS A minimally invasive approach for benign atrial tumor resection is effective, safe, and reproducible. Of the atrial tumors, 74.5% were myxoma and 82% were located in the left atrium. A low 30-day mortality rate with no manifestation of recurrent intracardiac tumor was observed.
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Affiliation(s)
- Karel M Van Praet
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| | - Kristin Wilkens
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
| | - Simon H Sündermann
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| | - Alexander Meyer
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| | - Matthias Hommel
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
| | - Stephan Jacobs
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
- Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
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Meng XH, Xie LS, Xie XP, Liu YC, Huang CP, Wang LJ, Zhang GH, Xu D, Cai XC, Fang X. Cardiac myxoma shedding leads to lower extremity arterial embolism: A case report. World J Clin Cases 2022; 10:10606-10613. [PMID: 36312464 PMCID: PMC9602238 DOI: 10.12998/wjcc.v10.i29.10606] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/07/2022] [Accepted: 09/08/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Left cardiac myxoma (CM) is the most common benign tumor of primary cardiac tumors, but because of its special position caused by pathological physiology change, caused by the complications of the heavier, the surface is often accompanied by blood clots, once fall out, it causes peripheral vascular embolization, such as acute lower limb artery embolization, harmfulness is large, high morbidity, and easy to occur repeatedly.
CASE SUMMARY A 67-year-old male patient suddenly appeared numbness and weakness of the left lower limb and could not walk without obvious incentive. The patient was finally diagnosed as left CM complicated with acute lower limb arterial embolism after completing cardiac ultrasound, computer tomography angiography, and histopathological analysis, such as hematoxylin-eosin stain staining, immunohistochemistry and special staining including alcian blue staining and periodic acid schiff staining. Arterial thrombosis was removed successfully by femoral artery thrombectomy, postoperative numbness and weakness of the patient's left lower limb disappeared, skin temperature became warm, and dorsal foot artery pulsation was accessible. The patient was readmitted to the hospital 8 mo after discharge for left atrial mass resection, and was diagnosed as CM by postoperative histopathological examination.
CONCLUSION Although CM is rare, it may be considered as the source of embolism in patients with acute limb ischemia. Repeated loss of thrombus on the tumor and its surface may lead to repeated embolism of peripheral vessels. Cardiac ultrasound is helpful for early diagnosis. Here, we use this case report to highlight left CM as an important cause of acute limb ischemia and to report our experience in the diagnosis and treatment of lower limb arterial embolism caused by CM detachment.
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Affiliation(s)
- Xiao-Hu Meng
- Department of Vascular Surgery, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Le-Si Xie
- Department of Pathology, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Xu-Pin Xie
- Department of Vascular Surgery, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Yong-Chang Liu
- Department of Vascular Surgery, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Chang-Pin Huang
- Department of General Surgery, Hangzhou Geriatrics Hospital, Hangzhou 310006, Zhejiang Province, China
| | - Lin-Jun Wang
- Department of Vascular Surgery, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Guo-Hui Zhang
- Department of General Surgery, Hangzhou Geriatrics Hospital, Hangzhou 310006, Zhejiang Province, China
| | - Dong Xu
- Department of Vascular Surgery, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Xu-Chao Cai
- Department of General Surgery, Hangzhou Geriatrics Hospital, Hangzhou 310006, Zhejiang Province, China
| | - Xin Fang
- Department of Vascular Surgery, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
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Abstract
Primary cardiac tumours for which surgical resection is the main stay of treatment are rare and present both diagnostic and management challenges. The majority of patients are asymptomatic and one third of those who have symptoms present with vague constitutional symptoms which further complicates the process of early diagnosis. The current state-of-the art multi-modality imaging, routine use of intra-operative transoesophageal echocardiogram (TOE) in most cardiac centres and the tremendous advances of endoscopic adjuncts greatly enhances both the diagnosis and management of those group of patients. The surgical burden of median sternotomy and the contemporary trend towards less invasive surgery urged the necessity for adopting minimally invasive surgery in general and cardiac tumours are no exception. Despite the rarity of theses tumours, minimally invasive resection is successful in the hands of experienced minimally invasive surgeons who employ the same minimal access valve surgery platform to access the tumours in various cardiac chambers and valves with no compromise to the oncological clearance and hence achieve the benefits of minimally invasive surgery without compromising long term outcomes.
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Affiliation(s)
- Ayman Kenawy
- Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Teaching Hospital, Blackpool, UK
| | - Abdelrahman Abdelbar
- Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Teaching Hospital, Blackpool, UK
| | - Joseph Zacharias
- Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Teaching Hospital, Blackpool, UK
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9
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Almeida FS, Canevazzi GJ, Rocha PB, Sobral ACCM, Sobral MLP. Tumoration in Anterior Leaflet of the Mitral Valve. Braz J Cardiovasc Surg 2021; 36:116-119. [PMID: 33594865 PMCID: PMC7918378 DOI: 10.21470/1678-9741-2020-0557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | | | - Priscila Barão Rocha
- Faculdade de Medicina, Centro Universitário das Américas, São Paulo, São Paulo, Brazil
| | | | - Marcelo Luiz Peixoto Sobral
- Faculdade de Medicina, Centro Universitário das Américas, São Paulo, São Paulo, Brazil.,Departament of Cardiovascular Surgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil.,Post Graduate Department of Cardiovascular and Thoracic Surgery, Universidade de São Paulo, Instituto do Coração, São Paulo, São Paulo, Brazil
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10
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Moscarelli M, Rahouma M, Nasso G, di Bari N, Speziale G, Bartolomucci F, Pepe M, Fattouch K, Lau C, Gaudino M. Minimally invasive approaches to primary cardiac tumors: A systematic review and meta-analysis. J Card Surg 2020; 36:483-492. [PMID: 33259109 DOI: 10.1111/jocs.15224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Cardiac tumors are rare conditions. The vast majority of them are benign yet they may lead to serious complications. Complete surgical resection is the gold standard treatment and should be performed as soon as the diagnosis is made. Median sternotomy (MS) is the standard approach and provides excellent early outcomes and durable results at follow-up. However, minimally invasive (MI) is gaining popularity and its role in the treatment of cardiac tumors needs further clarification. METHODS A systematic literature review identified 12 candidate studies; of these, 11 met the meta-analysis criteria. We analyzed outcomes of 653 subjects (294 MI and 359 MS) with random effects modeling. Each study was assessed for heterogeneity. The primary endpoints were mortality at follow-up and tumor relapse. Secondary endpoints included relevant intraoperative and postoperative outcomes; tumor size was also considered. RESULTS There were no significant between-group differences in terms of late mortality (incidence rate ratio [IRR]: MI vs. MS, 0.98 [95% confidence interval [CI]: 0.25-3.82], p = .98). Few relapses (IRR: 1.13; CI: 0.26-4.88; p = .87) and redo surgery (IRR: 1.92; 95% CI: 0.39-9.53; p = .42) were observed in both groups; MI approach resulted in prolonged operation time but that did not influence the clinical outcomes. Tumor size did not significantly differ between groups. CONCLUSION Both MI and MS are associated with excellent early and late outcomes with acceptable survival rate and low incidence of recurrences. This study confirms that cardiac tumor may be approached safely and radically with a MI approach.
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Affiliation(s)
- Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | - Mohamed Rahouma
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Giuseppe Nasso
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | | | - Giuseppe Speziale
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | | | - Martino Pepe
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | - Christopher Lau
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, New York, USA
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