Primary Cardiac Tumours - Operative Treatment of 20 Patients

Summary

This report describes a series of 20 patients operated on for a primary cardiac tumour. The majority of the tumours (16) were benign myxomas; 12 of them were located in the left atrium, two in the right atrium and two were biatrial. Two lipomas were found; one was epicardial and the other was located in the left atrium. The only intraventricular tumour was a malignant left ventricular myosarcoma. The propensity of intracardiac tumours to embolize was distinctive. Nine of the 16 myxomas presented with peripheral embolization, and in two patients surgery was complicated by fatal perioperative cerebral embolization of myxomatous tissue. Furthermore, in one patient embolization of a left atrial lipoma necessitated amputation of her left arm before cardiac surgery. Late postoperative recurrences were found in two patients with atrial myxomas. In one of them, reoperation showed that the tumour had grown at that site in the interatrial septum where the original pedicle had been excised. One patient developed severe mitral valve regurgitation and underwent replacement with a prosthetic valve at reoperation. Otherwise our late follow-up study showed that the results of surgery were usually excellent even though mild echocardiographic abnormalities were not uncommon. Our experience emphasizes the embolic potential of intracardiac myxomas and suggests, furthermore, that to avoid recurrences excisions with wide margins should be preferred. Echocardiography is an optimal method for the follow-up of these patients.

Zusammenfassung

Es wird über 20 Patienten mit einem primären Herztumor berichtet. Es handelte sich um 16 benigne Myxome, 2 Lipome und 2 maligne Myosarkome. In der folgenden detaillierten Darstellung wird sich auf die 16 Myxome konzentriert. Unter den 16 Myxomen kam es 9mal zu einer Tumorembolie in die Peripherie und in 2 Fällen kam es perioperativ zu einer zerebralen Embolisation von myxomatösem Gewebe. Ein linksatriales Lipom verursachte eine Tumorembolie in den linken Arm mit der Folge einer erforderlichen Amputation dieser Extremität. In einem Myxomfall trat ein spätes postoperatives Rezidiv auf, in einem anderen Fall machte eine postoperativ aufgetretene Mitralinsuffizienz den Klappenersatz erforderlich. In den anderen 14 Fällen war das postoperative Resultat gut, wenn auch gelegentlich geringe echokardiographische Abnormitäten festzustellen waren. Die Autoren weisen besonders auf das Embolierisiko solcher Patienten hin und betonen, daß eine ausreichend weite Exzision des Tumors im Gesunden mit dem Ziel der Rezidivvermeidung erforderlich ist.

Key words

Heart tumour - Myxoma - Lipoma - Sarcoma - Embolization - Echocardiograpy