Two Decades of Contemporary Surgery of Primary Cardiac Tumors

Large left atrial myxoma with synchronous laryngeal squamous cell carcinoma: A case report

BACKGROUND

Cardiac myxoma is a benign neoplasm and one of the most common types of primary cardiac tumors. Synchronous cardiac myxoma and other malignancies are extremely rare, and only limited cases have been reported.

CASE SUMMARY

We describe a young patient with newly diagnosed locally advanced laryngeal cancer, with a synchronous cardiac tumor detected on staging scans. An echocardiogram showed the typical appearance of myxoma in the left atrium. Early cardiac surgery was performed in view of its obstructive features and post cardiac surgery recovery was uneventful. The patient was scheduled for subsequent oncological treatment for the laryngeal cancer. However, due to rapid progression of the advanced laryngeal malignancy, he was placed on supportive care.

CONCLUSION

To our knowledge, this is the first reported case of synchronous cardiac myxoma with laryngeal malignancy. Individualized treatment strategy should be adopted to manage synchronous tumors in a multidisciplinary approach. The most life-threatening condition needs be treated first. Single resection, staged operations or simultaneous resection of both tumors have been reported with good outcomes.

Surgical treatment of primary cardiac tumors in the contemporary era: A single-centre analysis

Background

Primary cardiac tumors (PCT) are rare lesions but have the potential to cause significant morbidity if not timely treated. We reviewed our single‐center experience in the surgical treatment of PCT with a focus on the long‐term outcome.

Methods

From 2001 to 2020, 57 consecutive patients underwent surgical resection of PCT at our Institution. Data including the demographic characteristics, tumor histology, surgical procedure, and postoperative outcomes were collected and analyzed.

Results

Mean age at presentation was 63.6 ± 11.2 years, and 33 (57.9%) of the patients were female. A total of 55 (96.5%) subjects were diagnosed with benign cardiac tumor, while the remaining had malignant tumors. The most common histopathological type was myxoma. All patients survived to hospital discharge. Main postoperative complications were: acute kidney injury (n = 3), sepsis (n = 3), and stroke (n = 2). Mean follow‐up time was 9 ± 5.9 years. Long‐term mortality was 22.8% (13/57). No tumor recurrence was observed among survivors. There was a significant relationship between mortality and pathological characteristics of the tumor, and myxomas had higher survival rates.

Conclusion

Surgical treatment of PCT is a safe and highly effective strategy associated with excellent short‐term outcomes. Long‐term survival remains poor for primary malignant tumors of the heart.

What Influences the Patients with Left Atrial Myxoma: From Embolism to Postoperative Atrial Fibrillation

BACKGROUND

Preoperative embolism and postoperative atrial fibrillation (POAF) are two important factors associated with impaired health conditions and increased economic burden in patients with left atrial (LA) myxoma. The aim of this study was to analyze embolic events, identify predictors of POAF, and evaluate the risk of late-term survival in patients with LA myxoma.

METHODS

From December 2009 to December 2019, 177 consecutive patients with LA myxoma who met the selection criteria were included in the retrospective analysis. Multivariate logistic regression analysis was performed to identify predictors of POAF. Propensity score matching was used for confounder control, and Cox proportional hazards models were used to evaluate the risk of late-term mortality.

RESULTS

The study population comprised of 125 patients in non-POAF group and 52 patients in POAF group. Preoperative embolism was present in 27.1% of the all cases. By multivariate analysis, age, NYHA functional class III, LA diameter, and cross-clamp time were identified as independent predictors of in-hospital POAF. The overall survival at 1, 5, and 10 years for the 177 patients was 98.9%, 93.7%, and 84.4%, respectively. There was no statistical difference in late-term survival between the two groups in the Cox proportion-adjusted survival curve. After propensity score 1:1 matching, patients with POAF had a longer postoperative hospital stay and Kaplan-Meier survival curve also showed no statistical difference between the two groups.

CONCLUSIONS

Patients with LA myxoma after surgical treatment had a favorable prognosis. In-hospital POAF was not independently associated with late-term mortality in patients with LA myxoma.

A Case of Ewing Sarcoma Presenting With Cardiac Metastasis

Ewing sarcoma is the second most prevalent primary malignant bone tumor. Metastases from Ewing sarcoma to the heart are very rare. Herein, we present a case of undiagnosed Ewing sarcoma in a 12-year-old boy who presented with metastasis to the left atrium. The mass was prolapsing across the mitral valve. In view of the potential risk of embolization, urgent cardiac surgery was performed before the establishment of a definitive diagnosis. Histopathology was consistent with Ewing sarcoma. Subsequent magnetic resonance imaging revealed a mass in his left fibula. The patient was referred to the oncology center and received chemotherapy. One year later, he is alive with no evidence of recurrent cardiac involvement.