Improved surgical approach to cardiac tumors with intraoperative two-dimensional echocardiography

Cardiac Neoplasms

Surgical resection is usually the only form of curative therapy available for primary cardiac neoplasms. Benign tumors can often be completely removed with few complications and a low mortality rate, but complete resection is possible for fewer than half of primary malignant tumors. Radiation therapy plays an adjunct and palliative role in treatment. The outcome of chemotherapy, the dominant treatment method, is poor. Sarcomas are inherently chemoresistant and show a response rate of less than 50%. Lymphomas present late and respond poorly. Cardiectomy and cardiac transplantation may cure unresectable benign cardiac tumors or, rarely, malignant ones.

Atrial myxoma: report of 24 operations using the biatrial approach

Between October 1978 and June 1993, 24 consecutive operations for atrial myxoma were performed on 23 patients at the Damascus University Cardiovascular Surgical Center, using the biatrial approach. Fifteen of the patients were female; ages ranged between 4 and 71 years. Nineteen patients had symptoms of left and 3 of right atrioventricular obstruction. One patient presented with a cerebrovascular accident, and another with recurrent emboli to the lower extremities. Ten patients had constitutional manifestations. Diagnosis was established preoperatively in all patients by echocardiography with or without angiocardiography. Twenty-one patients had left atrial myxoma, 1 of whom had a double lesion. Two patients had right atrial myxoma; in 1 of them it extended to the left atrium. This last patient had the only recurrence in the series, which was removed 7 years after the initial operation. All tumors were excised with a wide margin of full-thickness septum. Four patients had concomitant mitral valve reconstruction. There was no hospital mortality, and follow-up did not reveal any other complication related to the operation.

Primary cardiac angiosarcoma: a case report and review of therapeutic options

A 45-year-old black patient presented with right-heart failure. Echocardiography showed a large tumor mass in the right atrium and a debulking procedure was performed. Histological and immunohistochemical studies revealed a high grade angiosarcoma infiltrating the myocardium and extending to the pericardial surface. Metastatic work-up showed no evidence of dissemination. The patient made an uneventful postsurgical recovery and was treated with chemotherapy, consisting of epidoxorubicin and dacarbazin. Following chemotherapy, echocardiographic re-evaluation failed to show any residual tumor in the right atrium. At present, one year following diagnosis, the patient is alive with no evidence of disease. Therapeutic options of primary cardiac angiosarcoma are reviewed.

Left atrial myxoma: excision guided by transesophageal cross-sectional echocardiography

We present a patient with a left atrial myxoma in whom the intraoperative use of transesophageal cross-sectional echocardiography proved helpful in selecting the most appropriate surgical approach, thus allowing expeditious and complete excision of the tumor. This technique, which permits continuous monitoring of cardiac function throughout open heart procedures, appears particularly valuable in patients with intracardiac masses.

Considerations in the surgical management of left atrial myxoma

Myxomas are the most common tumors of the heart. They are frequently located in the left atrium and produce symptoms when they fragment and cause systemic emboli or when they interfere with cardiac valvular function and cause pulmonary congestion. Careful surgical management of these lesions should be curative with minimum early and late morbidity and mortality. Optimal operative technique emphasizes minimal manipulation of the heart before institution of cardiopulmonary bypass and aortic cross-clamping and careful examination of intracardiac chambers with meticulous removal of myxomatous debris. Using these techniques, 17 patients have been treated successfully at the Brigham and Women's Hospital. There were no operative deaths and no significant perioperative morbidity. Fifteen patients are asymptomatic, and one patient has minimal shortness of breath an average of 57 months after surgery. One patient died of leukemia 15 months postoperatively. No recurrent myxomas have been identified, and no patients have symptoms of other cardiac disease.