51
|
Abstract
Cardiac tumours are a rare, but often devastating, clinical diagnosis. They encompass a broad set of lesions that include both neoplastic and non-neoplastic conditions. Cardiac tumours are often diagnosed incidentally during work-up for other conditions, or during ultrasound, CT, or MRI scans for unusual or nonspecific symptoms. In the past decade, important changes have been made in the nomenclature and the recommendations for diagnosis of cardiac tumours, as highlighted by the WHO's 2015 revision of the classification of cardiac tumours. Moreover, important advances in molecular genetics and therapeutics offer new approaches for the diagnosis and treatment of affected patients. In this Review, we provide an overview of the clinical, pathological, and imaging characteristics of all types of cardiac masses, including both benign and malignant primary cardiac neoplasms.
Collapse
|
52
|
Scollon S, Anglin AK, Thomas M, Turner JT, Wolfe Schneider K. A Comprehensive Review of Pediatric Tumors and Associated Cancer Predisposition Syndromes. J Genet Couns 2017; 26:387-434. [PMID: 28357779 DOI: 10.1007/s10897-017-0077-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 01/30/2017] [Indexed: 12/11/2022]
Abstract
An understanding of the role of inherited cancer predisposition syndromes in pediatric tumor diagnoses continues to develop as more information is learned through the application of genomic technology. Identifying patients and their relatives at an increased risk for developing cancer is an important step in the care of this patient population. The purpose of this review is to highlight various tumor types that arise in the pediatric population and the cancer predisposition syndromes associated with those tumors. The review serves as a guide for recognizing genes and conditions to consider when a pediatric cancer referral presents to the genetics clinic.
Collapse
Affiliation(s)
- Sarah Scollon
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Cancer Center, Texas Children's Hospital, 1102 Bates St, FC 1200, Houston, TX, 77030, USA.
| | | | | | - Joyce T Turner
- Department of Genetics and Metabolism, Children's National Medical Center, Washington, DC, USA
| | - Kami Wolfe Schneider
- Department of Pediatrics, University of Colorado, Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, CO, USA
| |
Collapse
|
53
|
Han X, Song H, Zhou L, Jiang C. Surgical resection of right ventricular rhabdomyoma under the guidance of transesophageal echocardiography on a beating heart. J Thorac Dis 2017; 9:E215-E218. [PMID: 28449506 DOI: 10.21037/jtd.2017.02.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Cardiac rhabdomyoma, a type of benign myocardial tumor, is regarded as the most common fetal cardiac tumor. Rhabdomyomas are usually found before birth or during the first year of life. It is widely accepted that rhabdomyomas are strongly associated with tuberous sclerosis, and tend to regress spontaneously without surgical excision. However, if the tumor has caused significant obstruction or refractory arrhythmias, the surgery should be advocated. Most of the surgeries for pediatric cardiac tumors are performed under cardiopulmonary bypass (CPB) with cardioplegia. Here, we present a case of successful resection of a right ventricular rhabdomyoma obstructing the right ventricular outflow tract (RVOT) and involving pulmonary valve annulus in an infant, performed under the guidance of transesophageal echocardiography (TEE) on a beating heart.
Collapse
Affiliation(s)
- Xueguang Han
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Haibo Song
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Li Zhou
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chunling Jiang
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, China
| |
Collapse
|
54
|
Chang JS, Chiou PY, Yao SH, Chou IC, Lin CY. Regression of Neonatal Cardiac Rhabdomyoma in Two Months Through Low-Dose Everolimus Therapy: A Report of Three Cases. Pediatr Cardiol 2017; 38:1478-1484. [PMID: 28780710 PMCID: PMC5628183 DOI: 10.1007/s00246-017-1688-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/14/2017] [Indexed: 11/27/2022]
Abstract
Cardiac rhabdomyoma (CR) is the most common cardiac tumor in newborns. Approximately 75% of cases are associated with tuberous sclerosis complex. Although these tumors usually spontaneously regress after 2 years of age, they can be life-threatening when they obstruct major cardiac inflow or outflow pathways. Everolimus is an inhibitor of the mammalian target of rapamycin, reducing its production of the proteins harmartin and tuberin. Everolimus has demonstrated a remarkable suppression effect in children with tuberous sclerosis complex at doses of 4.7-5.6 mg/M2/day and serum trough levels of 5-15 ng/mL. Since 2012, five case reports of neonates with CR have also reported the tumor-regressing effect of everolimus. However, the optimal dosage for neonates is still unknown. Over the past 2 years, we have deliberately used a low dose everolimus regimen (0.3-0.67 mg/M2/day) in three neonates with large CRs, in an effort to maintain serum trough levels at 3-7 ng/mL. In all three cases, the tumors regressed smoothly within 2 months. Regarding the drug's side effect of predisposing patients to infection, we observed that adenovirus pneumonia occurred in one case at 3 months of age, and chicken pox occurred in another case at 9 months of age; both recovered smoothly. Our three cases of neonatal CR demonstrate that a low-dose everolimus regimen is an effective treatment for tumor regression.
Collapse
Affiliation(s)
- Jeng-Sheng Chang
- Division of Pediatric Cardiology, China Medical University Children's Hospital, 2 Yu-Der Rd., North district, Taichung, 40447, Taiwan.
- School of Medicine, College of Medicine, China Medical University, Taichung, 40447, Taiwan.
| | - Ping-Yun Chiou
- Division of Pediatric Cardiology, China Medical University Children's Hospital, 2 Yu-Der Rd., North district, Taichung, 40447, Taiwan
| | - Shu-Hui Yao
- Department of Pharmacy, China Medical University Hospital, Taichung, 40447, Taiwan
| | - I-Ching Chou
- Pediatric Neurology, China Medical University Children's Hospital, Taichung, 40447, Taiwan
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, 40447, Taiwan
| | - Ching-Yuang Lin
- Pediatric Nephrology, China Medical University Children's Hospital, Taichung, 40447, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, 40447, Taiwan
| |
Collapse
|
55
|
Mankad R, Herrmann J. Cardiac tumors: echo assessment. Echo Res Pract 2016; 3:R65-R77. [PMID: 27600455 PMCID: PMC5292983 DOI: 10.1530/erp-16-0035] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/02/2016] [Indexed: 12/20/2022] Open
Abstract
Cardiac tumors are exceedingly rare (0.001–0.03% in most autopsy series). They can be present anywhere within the heart and can be attached to any surface or be embedded in the myocardium or pericardial space. Signs and symptoms are nonspecific and highly variable related to the localization, size and composition of the cardiac mass. Echocardiography, typically performed for another indication, may be the first imaging modality alerting the clinician to the presence of a cardiac mass. Although echocardiography cannot give the histopathology, certain imaging features and adjunctive tools such as contrast imaging may aid in the differential diagnosis as do the adjunctive clinical data and the following principles: (1) thrombus or vegetations are the most likely etiology, (2) cardiac tumors are mostly secondary and (3) primary cardiac tumors are mostly benign. Although the finding of a cardiac mass on echocardiography may generate confusion, a stepwise approach may serve well practically. Herein, we will review such an approach and the role of echocardiography in the assessment of cardiac masses.
Collapse
Affiliation(s)
- Rekha Mankad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
56
|
Hawkins RB, Rosenberger LH, Swanson JC, Gangemi JJ, McGahren ED. Excision of an intrapericardial immature teratoma in a 26-week premature neonate. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016; 10:29-31. [PMID: 27350936 PMCID: PMC4920356 DOI: 10.1016/j.epsc.2016.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We present a case of a 26 week premature newborn with an immature intrapericardial teratoma. The patient was transferred from an outside hospital for management of a large mediastinal mass causing respiratory insufficiency. The newborn was supported with the help of a large interdisciplinary team until day of life 22 when he underwent surgical excision. On follow up the infant is doing very well and is one of the youngest survivors to date.
Collapse
Affiliation(s)
- Robert B. Hawkins
- Division of Thoracic & Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Laura H. Rosenberger
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Julia C. Swanson
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - James J. Gangemi
- Division of Thoracic & Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Eugene D. McGahren
- Division of Pediatric Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
57
|
Jurkiewicz E, Bekiesińska-Figatowska M, Romaniuk-Doroszewska A, Dangel J. Brain MRI in Fetuses with Cardiac Tumours. Neuroradiol J 2016; 20:494-9. [DOI: 10.1177/197140090702000503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Accepted: 06/03/2007] [Indexed: 11/15/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant multisystem disorder which affects the skin, brain, heart and other organs. It is caused by mutations of two genes: TSC1 (on chromosome 9q34) or TSC2 (on 16p13.3). 70% of cases are sporadic with new mutations. This study aimed to highlight the utility of prenatal MRI as an adjunct imaging modality in the diagnosis and prognosis of tuberous sclerosis complex. Prenatal ultrasound and magnetic resonance imaging were performed in seven fetuses at a gestational age of 30, 32, 34 and 35 weeks using a 1.5 T MRI scanner. SSFSE,T2- and FGRE/T1-weighted images were obtained in axial, coronal and sagittal planes. Postnatal MRI was performed in two cases. Intracardiac tumors (rhabdomyomas) were revealed on ultrasound in all fetuses. On sonographic examination the brain tissue appeared normal in all cases. Brain MRI revealed focal low-signal-intensity lesions, localized along the walls of the lateral ventricles of five fetuses. Another hypointense lesion was seen at the grey/white matter junction in one case. Brain MRI of two fetuses was normal. The diagnosis of TSC was established in five cases. Postnatal MRI in two cases confirmed prenatal findings. MRI allows more complete evaluation of the fetus and helps to determine the diagnosis and prognosis in cases of TSC. The use of prenatal MR imaging in addition to prenatal sonography has the potential to improve genetic counseling and prenatal diagnosis of patients with tuberous sclerosis.
Collapse
Affiliation(s)
- E. Jurkiewicz
- MRI Unit, Children's Memorial Health Institute, Warsaw, Poland
| | | | | | - J. Dangel
- II Department of Gynecology and Obstetrics, Medical Academy; Warsaw, Poland
| |
Collapse
|
58
|
Mercado-Guzman MP, Meléndez-Ramírez G, Castillo-Castellon F, Kimura-Hayama E. [Evaluation of cardiac tumors by multidetector computed tomography and magnetic resonance imaging]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2016; 86:335-349. [PMID: 27210274 DOI: 10.1016/j.acmx.2016.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/02/2016] [Accepted: 04/06/2016] [Indexed: 11/25/2022] Open
Abstract
Cardiac tumors, are a rare pathology (0.002-0.3%) in all age groups, however, they have a clinic importance, due the affected organ. They are classified in primary (benign or malignant) and secondary (metastasis) types. Among primary type, mixoma, is the most common benign tumor, and sarcoma represents most of the malignant injuries. Cardiac metastasis are more frequent than primary tumors. Clinic effects of cardiac tumors are unspecific and vary according their location, size and agresivity. The use of Multidetector Computed Tomography (MDCT) and Magnetic Resonance Imaging (MRI) assist on the location, sizing, anatomical relationships and the compromise of adyacents structures, besides, MRI is useful for tissue characterization of the tumor. Due to the previous reasons, studies based on noninvasive cardiovascular imaging, have an important role on the characterization of these lesions and the differential diagnosis among them.
Collapse
Affiliation(s)
- Marcela P Mercado-Guzman
- Departamento de Tomografía Cardiaca, Instituto Nacional de Cardiología Ignacio Chávez, México, DF, México
| | - Gabriela Meléndez-Ramírez
- Departamento de Resonancia Magnética, Instituto Nacional de Cardiología Ignacio Chávez, México, DF, México
| | | | - Eric Kimura-Hayama
- Departamento de Tomografía Cardiaca, Instituto Nacional de Cardiología Ignacio Chávez, México, DF, México.
| |
Collapse
|
59
|
Yin L, He D, Shen H, Ling X, Li W, Xue Q, Wang Z. Surgical treatment of cardiac tumors: a 5-year experience from a single cardiac center. J Thorac Dis 2016; 8:911-9. [PMID: 27162666 DOI: 10.21037/jtd.2016.03.87] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cardiac tumors are rare but manifested with various clinical presentations and often cause unexpected symptoms or sudden death. The objective is to review the clinical presentation, histopathological spectrum, mortality and follow-up data of patients with cardiac tumors following surgery treatment over a period of 5 years. METHODS We retrospectively collected the medical records of all patients diagnosed of cardiac tumors in the period between January 2008 and December 2013 at the cardiac center of our university. Clinical histories, perioperative data, surgical findings, efficacy and follow-up data were reviewed in our study. Patients were divided into two groups according to site distribution of the tumors in the heart. RESULTS A total of 131 patients underwent surgical treatment of cardiac tumors were enrolled in this study, with a mean age of 51.39±16.37. The result of analysis showed that 79.47% (n=104) of the primary intracardiac tumors were benign, while primary malignant neoplasms accounted for 16.03% (n=21) of all patients, with the remainder (n=6, 4.6%) metastatic tumors transferred from other organs. Among all patients there were 2 in-hospital deaths and the survival rate in all patients at 1-year, 3-year and 5-year follow up was 83.20%, 78.62% and 66.41% respectively. Both patients with tumors in the left and right heart had similar basic characteristics except sex gender (P=0.002), BSA (P=0.045) and weight (P=0.033). Compared with patients with tumors in the right heart, patients with tumors in the left heart had significant higher CPB time (P<0.001), cross clamp time (P<0.001) and time of mechanical ventilation (P<0.001), and they also had longer ICU stay (P<0.001) but not total hospital stay (P=0.434). CONCLUSIONS Surgical resection represents an effective protocol in treating cardiac tumors. Data in our study of cardiac tumors on frequency and allocation were consistent with previous reports which may provide useful clinical evidence on shared data, and data revealed that patients with malignant cardiac tumors had significant lower survival both in hospital and long-term follow-up.
Collapse
Affiliation(s)
- Liang Yin
- Department of Cardiothoracic Surgery, Changzheng Hospital, the Second Military Medical University, Shanghai 200003, China
| | - Dengke He
- Department of Cardiothoracic Surgery, Changzheng Hospital, the Second Military Medical University, Shanghai 200003, China
| | - Hua Shen
- Department of Cardiothoracic Surgery, Changzheng Hospital, the Second Military Medical University, Shanghai 200003, China
| | - Xinyu Ling
- Department of Cardiothoracic Surgery, Changzheng Hospital, the Second Military Medical University, Shanghai 200003, China
| | - Wei Li
- Department of Cardiothoracic Surgery, Changzheng Hospital, the Second Military Medical University, Shanghai 200003, China
| | - Qian Xue
- Department of Cardiothoracic Surgery, Changzheng Hospital, the Second Military Medical University, Shanghai 200003, China
| | - Zhinong Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, the Second Military Medical University, Shanghai 200003, China
| |
Collapse
|
60
|
Hoshal SG, Samuel BP, Schneider JR, Mammen L, Vettukattil JJ. Regression of massive cardiac rhabdomyoma on everolimus therapy. Pediatr Int 2016; 58:397-399. [PMID: 26710725 DOI: 10.1111/ped.12816] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/29/2015] [Accepted: 08/24/2015] [Indexed: 11/30/2022]
Abstract
Cardiac rhabdomyoma is the primary feature of the genetic disease, tuberous sclerosis complex, the most common cardiac tumor diagnosed in neonates and infants. Spontaneous regression is observed in most cases, but these tumors may cause hemodynamic instability, arrhythmias or other complications. We describe the case of a critically ill neonate, resuscitated after cardiac arrest secondary to massive locally invasive cardiac rhabdomyoma, who was successfully treated with everolimus (mammalian target of rapamycin [mTOR] inhibitor). Rapid tumor regression was observed on echocardiography, but it was unlikely that it was confounded by the natural disease course of regression. The presented case suggests that mTOR inhibitors may play a significant role in the treatment of large cardiac rhabdomyomas in critically ill neonates.
Collapse
Affiliation(s)
- Steven G Hoshal
- College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Bennett P Samuel
- Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health, Grand Rapids, Michigan, USA
| | - Jeffrey R Schneider
- Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health, Grand Rapids, Michigan, USA
| | - Leena Mammen
- Advanced Radiology Services, PC, Grand Rapids, Michigan, USA
| | - Joseph J Vettukattil
- Congenital Heart Center, Helen DeVos Children's Hospital of Spectrum Health, Grand Rapids, Michigan, USA
| |
Collapse
|
61
|
Moavero R, Romagnoli G, Graziola F, Curatolo P. Mammalian Target of Rapamycin Inhibitors and Life-Threatening Conditions in Tuberous Sclerosis Complex. Semin Pediatr Neurol 2015; 22:282-94. [PMID: 26706015 DOI: 10.1016/j.spen.2015.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Tuberous sclerosis complex (TSC) is a multisystem disease associated with an overall reduction in life expectancy due to the possible occurrence of different life-threatening conditions. Subjects affected by TSC are, in fact, at risk of hydrocephalus secondary to the growth of subependymal giant cell astrocytomas, or of sudden unexpected death in epilepsy. Other nonneurological life-threatening conditions include abdominal bleeding owing to renal angiomyolipomas rupture, renal insufficiency due to progressive parenchymal destruction by multiple cysts, pulmonary complications due to lymphangioleiomyomatosis, and cardiac failure or arrhythmias secondary to rhabdomyomas. In the last decades, there has been a great progress in understanding the pathophysiology of TSC-related manifestations, which are mainly linked to the hyperactivation of the so-called mammalian target of rapamycin (mTOR) pathway, as a consequence of the mutation in 1 of the 2 genes TSC1 or TSC2. This led to the development of new treatment strategies for this disease. In fact, it is now available as a biologically targeted therapy with everolimus, a selective mTOR inhibitor, which has been licensed in Europe and USA for the treatment of subependymal giant cell astrocytomas and angiomyolipomas in subjects with TSC. This drug also proved to benefit other TSC-related manifestations, including pulmonary lymphangioleiomyomatosis, cardiac rhabdomyomas, and presumably epileptic seizures. mTOR inhibitors are thus proving to be a systemic therapy able to simultaneously address different and potentially life-threatening complications, giving the hope of improving life expectation in individuals with TSC.
Collapse
Affiliation(s)
- Romina Moavero
- Child Neurology and Psychiatry Unit, Tor Vergata University Hospital of Rome, Rome, Italy; Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Gloria Romagnoli
- Child Neurology and Psychiatry Unit, Tor Vergata University Hospital of Rome, Rome, Italy
| | - Federica Graziola
- Child Neurology and Psychiatry Unit, Tor Vergata University Hospital of Rome, Rome, Italy
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, Tor Vergata University Hospital of Rome, Rome, Italy
| |
Collapse
|
62
|
Shah IK, Dearani JA, Daly RC, Suri RM, Park SJ, Joyce LD, Li Z, Schaff HV. Cardiac Myxomas: A 50-Year Experience With Resection and Analysis of Risk Factors for Recurrence. Ann Thorac Surg 2015; 100:495-500. [PMID: 26070596 DOI: 10.1016/j.athoracsur.2015.03.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Myxomas are the most common cardiac tumors, but there are insufficient data regarding long-term survival and recurrence rates. Our objective was to examine late results and attempt to determine a strategy for recurrence monitoring, as there are no recommended guidelines at present. METHODS We performed a retrospective analysis of 194 patients (mean age 57.2 ± 15.6 years; 62.4% female) undergoing resection of cardiac myxoma from June 1955 to June 2011. The left atrium (n = 155, 80%) was the most common location, and the mean tumor size was 4.3 ± 2.1 cm by 3.2 ± 1.6 cm by 2.1 ± 1.3 cm. Dyspnea (n = 68) and palpitations (n = 57) were the most common complaints, and 28 patients (14.4%) were asymptomatic. RESULTS The tumor was exposed through the respective atria in the majority of patients (n = 187). Bypass and cross-clamp times were 59.1 ± 33.4 minutes and 35.2 ± 21.7 minutes, respectively. Two thirds of the tumors were excised with an endocardial button, and the rest were resected at the base of the stalk. Operative mortality was 0.5%. Ten, 20 and 30-year survival was 77%, 52% and 34%, respectively, which was comparable to an age-matched general population (p = 0.191). Older age at operation was the only significant predictor of subsequent mortality (p < 0.001). There was no significant difference in survival when patients were stratified by sex (p = 0.784), location of tumor (p = 0.087), the largest tumor dimension (p = 0.257) or surgical technique (endocardial button versus base of the stalk, p = 0.502). Tumors recurred in 11 patients; freedom from tumor recurrence was 92%, 91%, and 86% at 10, 20, and 30 years, respectively. Younger age at surgery (hazard ratio 0.94, p = 0.002), smaller tumor dimension (hazard ratio 0.58, p = 0.011), and tumor localized to the ventricles (hazard ratio 7.29, p = 0.013) were predictors of recurrence. CONCLUSIONS Cardiac myxomas can be resected with low early mortality and excellent late survival. Tumor recurrence is more likely to occur in the first 10 postoperative years, especially in younger patients, patients with a smaller tumor mass, or tumor location in the ventricle. Patients with these findings require closer imaging surveillance in the first decade after resection.
Collapse
Affiliation(s)
- Ishan K Shah
- Divisions of Cardiovascular Surgery and Biomedical Statistics, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Joseph A Dearani
- Divisions of Cardiovascular Surgery and Biomedical Statistics, Mayo Clinic and Foundation, Rochester, Minnesota.
| | - Richard C Daly
- Divisions of Cardiovascular Surgery and Biomedical Statistics, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Rakesh M Suri
- Divisions of Cardiovascular Surgery and Biomedical Statistics, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Soon J Park
- Divisions of Cardiovascular Surgery and Biomedical Statistics, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Lyle D Joyce
- Divisions of Cardiovascular Surgery and Biomedical Statistics, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Zhuo Li
- Divisions of Cardiovascular Surgery and Biomedical Statistics, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Hartzell V Schaff
- Divisions of Cardiovascular Surgery and Biomedical Statistics, Mayo Clinic and Foundation, Rochester, Minnesota
| |
Collapse
|
63
|
Hageman A, Reardon LC. Apparent life-threatening events in infants: two unique presentations of rare cardiac diseases. Clin Pediatr (Phila) 2015; 54:683-5. [PMID: 25085930 DOI: 10.1177/0009922814545164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
64
|
Indications for cardiovascular magnetic resonance in children with congenital and acquired heart disease: an expert consensus paper of the Imaging Working Group of the AEPC and the Cardiovascular Magnetic Resonance Section of the EACVI. Cardiol Young 2015; 25:819-38. [PMID: 25739865 DOI: 10.1017/s1047951115000025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.
Collapse
|
65
|
Linnemeier L, Benneyworth BD, Turrentine M, Rodefeld M, Brown J. Pediatric Cardiac Tumors. World J Pediatr Congenit Heart Surg 2015; 6:215-9. [DOI: 10.1177/2150135114563938] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Cardiac tumors in children are rare. Of the cases reported in the literature, nearly all are benign and managed conservatively. Methods: This is a retrospective, observational study of pediatric patients <18 years who presented for surgical evaluation of a cardiac tumor, between 1969 and 2014 at a tertiary care children’s hospital. Presentation, pathology, management, and outcomes were evaluated. Results: Over the last 45 years, 64 patients were evaluated for surgical resection of a cardiac tumor. Rhabdomyoma was the most common neoplasm (58%), and 17% of the tumors had malignant pathologies. While 42% of benign cardiac neoplasms required surgical intervention for significant hemodynamic concerns, 73% of malignant neoplasms underwent radical excision, if possible, followed by adjuvant chemotherapy. Despite a 37% mortality in patients with malignant pathology, an aggressive surgical approach can yield long-term survival in some patients. There were no deaths among patients with benign tumors and 17% had postoperative complications mostly related to mitral regurgitation. Conclusion: Cardiac tumors in children are rare but can be managed aggressively with good outcomes. Benign tumors have an excellent survival with most complications related to tumor location. Malignant tumors have a high mortality rate, but surgery and adjuvant chemotherapy allow for prolonged survival in selected patients.
Collapse
Affiliation(s)
- Laura Linnemeier
- Department of Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brian D. Benneyworth
- Department of Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark Turrentine
- Department of Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark Rodefeld
- Department of Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John Brown
- Department of Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
66
|
Valsangiacomo Buechel ER, Grosse-Wortmann L, Fratz S, Eichhorn J, Sarikouch S, Greil GF, Beerbaum P, Bucciarelli-Ducci C, Bonello B, Sieverding L, Schwitter J, Helbing WA, Galderisi M, Miller O, Sicari R, Rosa J, Thaulow E, Edvardsen T, Brockmeier K, Qureshi S, Stein J. Indications for cardiovascular magnetic resonance in children with congenital and acquired heart disease: an expert consensus paper of the Imaging Working Group of the AEPC and the Cardiovascular Magnetic Resonance Section of the EACVI. Eur Heart J Cardiovasc Imaging 2015; 16:281-97. [PMID: 25712078 DOI: 10.1093/ehjci/jeu129] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.
Collapse
|
67
|
Hinton RB, Prakash A, Romp RL, Krueger DA, Knilans TK. Cardiovascular manifestations of tuberous sclerosis complex and summary of the revised diagnostic criteria and surveillance and management recommendations from the International Tuberous Sclerosis Consensus Group. J Am Heart Assoc 2014; 3:e001493. [PMID: 25424575 PMCID: PMC4338742 DOI: 10.1161/jaha.114.001493] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Robert B Hinton
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (R.B.H., T.K.K.)
| | - Ashwin Prakash
- Department of Cardiology, Boston Children's Hospital, Boston, MA (A.P.)
| | - Robb L Romp
- Division of Pediatric Cardiology, University of Alabama at Birmingham, AL (R.L.R.)
| | - Darcy A Krueger
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (D.A.K.)
| | - Timothy K Knilans
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (R.B.H., T.K.K.)
| | | |
Collapse
|
68
|
Martens T, Vandekerckhove K, François K, Bove T. Spindle cell sarcoma of the mitral valve: an unusual cause of acute coronary syndrome in a child. Ann Thorac Surg 2014; 98:1456-9. [PMID: 25282213 DOI: 10.1016/j.athoracsur.2013.11.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 10/21/2013] [Accepted: 11/11/2013] [Indexed: 11/17/2022]
Abstract
We present an unusual case of acute myocardial infarction by embolic obstruction of both the left anterior descending and right coronary arteries in a 14-year-old girl. Echocardiography showed mobile lesions on the mitral valve and into the left ventricular outflow tract with poor left ventricular function, eventually suggesting endocarditis. Successful surgery comprised mitral valve plasty after complete resection of the tumoral lesion, in association with coronary artery embolectomy. Histologic examination revealed a malignant spindle cell sarcoma treated with adjuvant chemotherapy. We emphasize here the differential diagnosis of acute coronary syndrome in children by a rare cardiac tumor.
Collapse
Affiliation(s)
- Thomas Martens
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium.
| | | | - Katrien François
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Thierry Bove
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
69
|
Left ventricular fibroma: What cardiac magnetic resonance imaging may add? Int J Cardiol 2014; 176:e63-5. [DOI: 10.1016/j.ijcard.2014.07.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 07/24/2014] [Indexed: 10/24/2022]
|
70
|
Tao TY, Yahyavi-Firouz-Abadi N, Singh GK, Bhalla S. Pediatric Cardiac Tumors: Clinical and Imaging Features. Radiographics 2014; 34:1031-46. [DOI: 10.1148/rg.344135163] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
71
|
Abstract
OBJECTIVE The purpose of this article is to describe the characteristic cardiac MRI features of primary and secondary cardiac tumors, including differentiation from masslike lesions, such as thrombus or focal myocardial hypertrophy. CONCLUSION The frequency and type of cardiac tumors in children differ from those in adults. Although transthoracic echocardiography is the initial imaging technique of choice for evaluation of cardiac tumors, cardiac MRI is an important complementary modality for characterization of the mass and effect on cardiac function.
Collapse
|
72
|
Abstract
Left ventricular (LV) myxoma is particularly rare in children and has not been reported in infants. A five-month-old baby presented with a myxoma arising from the anterior, lateral, and superior aspect of the LV, causing severe left ventricular outflow tract obstruction. The LV was accessed through the conal septum after opening the right ventricular outflow. The child had transient complete heart block in the postoperative period. There was no recurrence of tumor at the nine-month follow-up.
Collapse
Affiliation(s)
- Srinath N Reddy
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Cochin, Kerala, India
| | - Gs Sunil
- Department of Pediatric Cardiovascular Surgery, Amrita Institute of Medical Sciences, Cochin, Kerala, India
| | - Raman Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Cochin, Kerala, India
| |
Collapse
|
73
|
Abstract
Primary cardiac tumours in infants and children are extremely rare, with an estimated incidence of 0.2% according to echocardiographic studies. Owing to their rarity, there is very little literature available, and most knowledge is based on collections of case reports. Therefore, we reviewed retrospectively our 27 years of clinical experience on the overall management of cardiac tumours among children in order to improve not only our knowledge but also to provide others with information about the incidence, clinical presentation, management, and long-term outcome of this rare disease. Between April, 1982 and April, 2009, 52 children were diagnosed with cardiac tumours at our Institution. Medical records and follow-up echocardiographic evaluations were studied. The diagnosis was prenatal in 35% of the patients. The most frequent tumour types were rhabdomyomas (61.5%), fibromas (15.4%), and myxomas (5.8%). There were no cases of primary malignant tumours. All diagnoses were achieved using two-dimensional echocardiography, and for 12 patients a pathological analysis was carried out. A total of 41 patients (79%) were managed medically, whereas 11 (21%) patients underwent surgical treatment. At a mean follow-up of 7.2 ± 5.4 years, two patients died of complications related to cardiac transplantation; all the remaining patients are in excellent clinical condition. In conclusion, cardiac tumours in paediatric practice are usually clinically and histologically benign. Only a few cases need surgery. Up to one-third of the cardiac masses are detectable prenatally. Rhabdomyoma is the most common histotype, followed by fibroma and myxoma. The long-term prognosis is generally good.
Collapse
|
74
|
Shen Q, Shen J, Qiao Z, Yao Q, Huang G, Hu X. Cardiac rhabdomyomas associated with tuberous sclerosis complex in children. Herz 2014; 40:675-8. [DOI: 10.1007/s00059-014-4078-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/09/2014] [Accepted: 02/04/2014] [Indexed: 11/24/2022]
|
75
|
Bhattacharyya S, Khattar RS, Gujral DM, Senior R. Cardiac tumors: the role of cardiovascular imaging. Expert Rev Cardiovasc Ther 2013; 12:37-43. [PMID: 24345096 DOI: 10.1586/14779072.2014.872031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Evaluation of cardiac tumors with cardiovascular imaging aims to establish aetiology, identify complications of tumor and help define management strategy. 2D echocardiography remains the primary diagnostic modality. Additional use of newer echocardiographic techniques such as 3D, strain and contrast echocardiography better characterise tumor morphology, tissue characteristics and vascularity respectively. Cardiac MRI and computed tomography provide complementary information and are able to identify extra-cardiac infiltration and also provide further tissue characterisation. This review explores the non-invasive diagnostic approach to evaluation of cardiac tumors.
Collapse
|
76
|
Wacker-Gussmann A, Strasburger JF, Cuneo BF, Wiggins DL, Gotteiner NL, Wakai RT. Fetal arrhythmias associated with cardiac rhabdomyomas. Heart Rhythm 2013; 11:677-83. [PMID: 24333285 DOI: 10.1016/j.hrthm.2013.12.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Primary heart tumors in fetuses are rare and mainly represent rhabdomyomas. The tumors have a variable expression and can be associated with arrhythmias, including both wide and narrow QRS tachycardia. Although multiple Doppler techniques exist to assess fetal heart rhythm, it can be difficult to record precise electrophysiological abnormalities in fetal life. OBJECTIVE Investigations defining precise electrophysiological diagnosis were performed by using fetal magnetocardiography (fMCG). METHODS In addition to routine fetal echocardiography, fMCG was used to investigate electrophysiological rhythm patterns in a series of 10 fetuses with cardiac rhabdomyomas. RESULTS The mean gestational age of the fetuses was 28.6 ± 4.7 weeks. The multiple rhabdomyomas were mainly located in the right and left ventricles as well as around the atrioventricular groove. Arrhythmias or conduction abnormalities were diagnosed in all 10 patients, although only 6 of them were referred due to that indication. Remarkably, 80% (8 of 10) had associated Wolff-Parkinson-White pre-excitation. In addition, we found prominent P waves in 4 fetuses. CONCLUSION In fetuses with rhabdomyomas, a disease where rhythm pathology is common, precise electrophysiological diagnosis can now be made by fMCG. fMCG is complimentary to echocardiography for rhythm assessment and can detect conduction abnormalities that are not possible to diagnose prenatally with M-mode or pulsed Doppler ultrasound. Risk factor assessment using fMCG can support pregnancy management and postnatal treatment and follow-up.
Collapse
Affiliation(s)
| | - Janette F Strasburger
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Wisconsin-Milwaukee and Fox Valley, Milwaukee, Wisconsin
| | - Bettin F Cuneo
- Children's Hospital Colorado, University of Colorado School of Medicine, Denver, Colorado
| | - Delonia L Wiggins
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
| | - Nina L Gotteiner
- Division of Cardiology, Department of Pediatrics, Lurie Children's Hospital, Chicago, Illinois
| | - Ronald T Wakai
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin.
| |
Collapse
|
77
|
Affiliation(s)
- Zhi-Gang Chu
- Department of Radiology; The First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - Zhi-Yu Zhu
- Department of Stomatology; The First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - Meng-Qi Liu
- Department of Radiology; The First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - Fa-Jin Lv
- Department of Radiology; The First Affiliated Hospital of Chongqing Medical University; Chongqing China
| |
Collapse
|
78
|
Intramuscular small vessel arteriovenous malformation of the left ventricle in an asymptomatic adolescent: a case report and literature review. Cardiol Young 2013; 23:656-60. [PMID: 23694712 DOI: 10.1017/s1047951113000346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Primary vascular tumours of the heart are rare and heterogeneous in their presentation and classification.We present a primary intramuscular vascular malformation of the left ventricle in an asymptomatic 12-year-old girl. Characteristics on cardiac magnetic resonance imaging, specifically increased signal intensity on T2-weighted images, and marked contrast enhancement with gadolinium were suggestive of increased vascularity. Histologically, the mass was determined to be an intramuscular vascular malformation of the small vessel arteriovenous subtype. This represents one of a select few intramuscular vascular malformations of the left ventricle reported in children. Our patient remains completely asymptomatic and has had no change in the size and appearance of the mass after more than 30 months of follow-up.
Collapse
|
79
|
Northrup H, Krueger DA. Tuberous sclerosis complex diagnostic criteria update: recommendations of the 2012 Iinternational Tuberous Sclerosis Complex Consensus Conference. Pediatr Neurol 2013; 49:243-54. [PMID: 24053982 PMCID: PMC4080684 DOI: 10.1016/j.pediatrneurol.2013.08.001] [Citation(s) in RCA: 932] [Impact Index Per Article: 84.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 07/30/2013] [Accepted: 08/01/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tuberous sclerosis complex is highly variable in clinical presentation and findings. Disease manifestations continue to develop over the lifetime of an affected individual. Accurate diagnosis is fundamental to implementation of appropriate medical surveillance and treatment. Although significant advances have been made in the past 15 years in the understanding and treatment of tuberous sclerosis complex, current clinical diagnostic criteria have not been critically evaluated or updated since the last clinical consensus conference in 1998. METHODS The 2012 International Tuberous Sclerosis Complex Consensus Group, comprising 79 specialists from 14 countries, was organized into 12 subcommittees, each led by a clinician with advanced expertise in tuberous sclerosis complex and the relevant medical subspecialty. Each subcommittee focused on a specific disease area with important diagnostic implications and was charged with reviewing prevalence and specificity of disease-associated clinical findings and their impact on suspecting and confirming the diagnosis of tuberous sclerosis complex. RESULTS Clinical features of tuberous sclerosis complex continue to be a principal means of diagnosis. Key changes compared with 1998 criteria are the new inclusion of genetic testing results and reducing diagnostic classes from three (possible, probable, and definite) to two (possible, definite). Additional minor changes to specific criterion were made for additional clarification and simplification. CONCLUSIONS The 2012 International Tuberous Sclerosis Complex Diagnostic Criteria provide current, updated means using best available evidence to establish diagnosis of tuberous sclerosis complex in affected individuals.
Collapse
Affiliation(s)
- Hope Northrup
- Division of Medical Genetics, Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas.
| | - Darcy A. Krueger
- Division of Neurology, Department of Pediatrics, Cincinnati Children?s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | |
Collapse
|
80
|
Motwani M, Kidambi A, Herzog BA, Uddin A, Greenwood JP, Plein S. MR imaging of cardiac tumors and masses: a review of methods and clinical applications. Radiology 2013; 268:26-43. [PMID: 23793590 DOI: 10.1148/radiol.13121239] [Citation(s) in RCA: 239] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cardiac masses are usually first detected at echocardiography. In their further evaluation, cardiac magnetic resonance (MR) imaging has become a highly valuable technique. MR imaging offers incremental value owing to its larger field of view, superior tissue contrast, versatility in image planes, and unique ability to enable discrimination of different tissue characteristics, such as water and fat content, which give rise to particular signal patterns with T1- and T2-weighted techniques. With contrast material-enhanced MR imaging, additional tissue properties such as vascularity and fibrosis can be demonstrated. MR imaging can therefore contribute to the diagnosis of a cardiac mass as well as be used to detail its relationship to other cardiac and extracardiac structures. These assessments are important to plan therapy, such as surgical intervention. In addition, serial MR studies can be used to monitor tumor regression after surgery or chemotherapy. Primary cardiac tumors are very rare; metastases and pseudotumors (eg, thrombus) are much more common. This article provides an overview of cardiac masses and reviews the optimal MR imaging techniques for their assessment.
Collapse
Affiliation(s)
- Manish Motwani
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS2 9JT, England
| | | | | | | | | | | |
Collapse
|
81
|
Nield LE, Mendelson M, Ahmad N, Manlhiot C, Jaeggi ET, McCrindle BW. Clinical Review of Obstructive Primary Cardiac Tumors in Childhood. CONGENIT HEART DIS 2013; 9:244-51. [DOI: 10.1111/chd.12134] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Lynne E. Nield
- Labatt Family Heart Centre; Department of Pediatrics; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - Michael Mendelson
- Labatt Family Heart Centre; Department of Pediatrics; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - Nauman Ahmad
- Labatt Family Heart Centre; Department of Pediatrics; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - Cedric Manlhiot
- Labatt Family Heart Centre; Department of Pediatrics; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - Edgar T. Jaeggi
- Labatt Family Heart Centre; Department of Pediatrics; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - Brian W. McCrindle
- Labatt Family Heart Centre; Department of Pediatrics; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| |
Collapse
|
82
|
Davis JS, Allan BJ, Perez EA, Neville HL, Sola JE. Primary pediatric cardiac malignancies: the SEER experience. Pediatr Surg Int 2013; 29:425-9. [PMID: 23358917 DOI: 10.1007/s00383-013-3261-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 02/05/2023]
Abstract
PURPOSE Pediatric cardiac malignancies are exceedingly rare. We sought to examine demographics, presentation, and outcomes for this pathology. METHODS The SEER registry from 1973 to 2008 was queried for all patients <20 years of age with cardiac malignancies. RESULTS A total of 25 pediatric patients were identified with primary cardiac malignancies, with age-adjusted incidence of 0.00686 per 100,000 United States population. Median age at diagnosis was 10 years. The majority of patients were adolescent (n = 13, 52 %), Caucasian (n = 17, 68 %) and males (n = 14, 56 %). The most common histology was soft tissue sarcoma (n = 10, 40%), followed by non-Hodgkin lymphoma and teratoma (both n = 3, 12 %). Six patients presented with distant disease. More than half of patients (n = 16, 64 %) underwent surgical resection, while four patients (16 %) underwent radiation. The mean survival time for the cohort was 47 ± 67 months, with 14 (56 %) patients dying over the study period. Lymphomas had significantly longer survival than other malignancies (108 ± 66 vs. 36 ± 66, p = 0.03), while lack of surgical treatment was associated with worse survival (p = 0.016). CONCLUSIONS Primary malignant cardiac tumors are exceedingly rare in pediatric patients. They are most commonly soft tissue sarcomas and lymphomas demonstrated longer survival.
Collapse
Affiliation(s)
- James S Davis
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | | | | | | | | |
Collapse
|
83
|
Kocabaş A, Ekici F, Cetin Iİ, Emir S, Demir HA, Arı ME, Değerliyurt A, Güven A. Cardiac rhabdomyomas associated with tuberous sclerosis complex in 11 children: presentation to outcome. Pediatr Hematol Oncol 2013; 30:71-9. [PMID: 23151153 DOI: 10.3109/08880018.2012.734896] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cardiac rhabdomyomas (CRs) are the most common heart tumors in children and closely associated with tuberous sclerosis complex (TSC). This study was performed to assess the presentation type, clinical course, treatment modalities, and outcome of the patients with rhabdomyoma, associated with TSC. We reviewed our patients with cardiac rhabdomyomas (CRs), who had received a diagnosis of TSC previously or during the follow-up period between June 1996 and January 2012, retrospectively. Thirty-two patients with TSC were evaluated and among them 11 patients (34%) were associated with CRs. Five patients (45%) had multiple tumors and consequently a total of 29 CRs were analyzed in our study. The median follow-up period was 2 years (range: 1 week-15 years). Clinical presentation was cardiac murmur in three patients, cyanosis in two patients and arrhythmia in one patient. Five patients were asymptomatic at the diagnosis and CRs were detected during routine cardiac evaluation for TSC. Cardiac tumors were diagnosed prenatally in two patients. Spontaneous regression rate was 31% and we experienced a complete regression of a tumor with an echogenic bordered tissue defect and septal thinning in a patient. Three patients had hemodynamically significant tumor obstruction; two of them underwent surgery. The other patient, who had multiple CRs, was treated medically with everolimus because of high-risk potential of surgery. Although surgical resection is the preferred treatment in most of the patients with hemodynamic instability, we need novel alternative medical therapies in some critically ill patients who cannot be operated due to various reasons.
Collapse
Affiliation(s)
- Abdullah Kocabaş
- Department of Pediatric Cardiology, Ankara Children's Hematology Oncology Education and Research Hospital, Ankara, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
84
|
Cardiac tumors in infants and children: study of 120 operated patients. Pediatr Cardiol 2013; 34:125-8. [PMID: 22735896 DOI: 10.1007/s00246-012-0399-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 05/17/2012] [Indexed: 10/28/2022]
Abstract
Cardiac tumors in children are rare, and patient series are limited in size. We report 120 children who underwent surgery to treat a cardiac tumor; the tumor type was known in 108 instances. The patients represented <0.1 % of 130,000 cardiac surgeries performed in children from a multi-institutional data base. The most common tumors and the number of patients were rhabdomyoma (n = 42), myxoma (n = 28), and fibromas (n = 10). The remaining 18 tumors of various types occurred in smaller numbers of patients. Nine patients (7 %) died after surgery. The mean age of death was 14 days, and death was most frequent in patients with fibromas (n = 4). Considering the variety of tumors, their varied location in cardiac structures, the patient ages, and the infrequent occurrence in an individual surgeon's experience, the operative mortality was low.
Collapse
|
85
|
Beaton A, Kuttler T, Hassan A, Nath DS, Reyes C, Jonas RA, Martin GR. Hemangioendothelioma: a rare case of a primary intracardiac tumor. Pediatr Cardiol 2013; 34:194-7. [PMID: 22421960 DOI: 10.1007/s00246-012-0280-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 02/27/2012] [Indexed: 12/01/2022]
Abstract
Kaposiform hemangioendothelioma (KH) is a rare tumor of vascular origin that commonly affects the cutaneous tissues of the extremities. It can, however, affect the abdomen, thorax, head, or neck. Compared with juvenile hemangiomas, which tend to regress, KH tumors are locally aggressive and usually persist. Associated morbidity and mortality rates range from 12 to 30 % and typically are related to either compressive effects on surrounding vital structures or effects of the Kasabach-Merritt phenomenon [10, 11, 13]. To our knowledge, this report is the first to describe KH presenting as a primary intracardiac tumor.
Collapse
Affiliation(s)
- Andrea Beaton
- Children's National Medical Center, 111 Michigan Avenue, Washington, DC 20010, USA.
| | | | | | | | | | | | | |
Collapse
|
86
|
Neri M, Di Donato S, Maglietta R, Pomara C, Riezzo I, Turillazzi E, Fineschi V. Sudden death as presenting symptom caused by cardiac primary multicentric left ventricle rhabdomyoma, in an 11-month-old baby. An immunohistochemical study. Diagn Pathol 2012. [PMID: 23206573 PMCID: PMC3520811 DOI: 10.1186/1746-1596-7-169] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This case report describes a sudden cardiac death in an apparent healthy 11-month-old infant caused by a multifocal cardiac rhabdomyoma. Parents reported that a few days before the child had fallen to the ground getting a little superficial injury to the scalp. The authors hypothesize that it may have been a transient loss of consciousness episode caused by the cardiac tumour. After the gross examination, histological investigation supported by immunohistochemical analysis using antibody anti- Myoglobin, Actin, Vimentin, Desmin, CD34, S-100, Ki-67 was carried out for the diagnosis. Death was attributed to a multifocal cardiac rhabdomyoma, a benign tumour of striated muscle, which has been completely asymptomatic. In particular, one mass filled the entire posterior wall of the left ventricle. The insidious development of benign cardiac tumours also in infants and children is outlined, focusing on the responsible mechanisms of sudden death in such cases and providing a reference for additional study on these subjects.
Collapse
Affiliation(s)
- Margherita Neri
- Department of Forensic Pathology, University of Foggia, Ospedale Colonnello D'Avanzo, Via degli Aviatori 1, Foggia, 71100, Italy
| | | | | | | | | | | | | |
Collapse
|
87
|
Elahi M, Poh CL, Krishna A, Grant P. Surgical Considerations for Large Asymptomatic Cardiac Fibromas in the context of Fatal Ventricular Arrhythmias. Heart Lung Circ 2012; 21:750-3. [DOI: 10.1016/j.hlc.2012.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 02/24/2012] [Accepted: 03/03/2012] [Indexed: 11/28/2022]
|
88
|
Abstract
Cardiac tumours in infancy are rare and are mostly benign with rhabdomyomas, fibromas and teratomas accounting for the majority. The presentation depends on size and location of the mass as they tend to cause cavity obstruction or arrhythmias. Most rhabdomyomas tend to regress spontaneously but fibromas and teratomas generally require surgical intervention for severe haemodynamic or arrhythmic complications. Other relatively rare cardiac tumours too are discussed along with an Indian perspective.
Collapse
Affiliation(s)
- O P Yadava
- National Heart Institute, New Delhi, India.
| |
Collapse
|
89
|
|
90
|
Padalino MA, Vida VL, Boccuzzo G, Tonello M, Sarris GE, Berggren H, Comas JV, Di Carlo D, Di Donato RM, Ebels T, Hraska V, Jacobs JP, Gaynor JW, Metras D, Pretre R, Pozzi M, Rubay J, Sairanen H, Schreiber C, Maruszewski B, Basso C, Stellin G. Surgery for Primary Cardiac Tumors in Children. Circulation 2012; 126:22-30. [PMID: 22626745 DOI: 10.1161/circulationaha.111.037226] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
To evaluate indications and results of surgery for primary cardiac tumors in children.
Methods and Results—
Eighty-nine patients aged ≤18 years undergoing surgery for cardiac tumor between 1990 and 2005 from 16 centers were included retrospectively (M/F=41/48; median age 4.3 months, range 1 day to 18 years). Sixty-three patients (68.5%) presented with symptoms. Surgery consisted of complete resection in 62 (69.7%) patients, partial resection in 21 (23.6%), and cardiac transplant in 4 (4.5%). Most frequent histotypes (93.2%) were benign (rhabdomyoma, myxoma, teratoma, fibroma, and hemangioma). Postoperative complications occurred in 29.9%. Early and late mortality were 4.5% each (mean follow-up, 6.3±4.4 years); major adverse events occurred in 28.2% of the patients; 90.7% of patients are in New York Heart Association class I. There were no statistically significant differences in survival, postoperative complications, or adverse events after complete and partial resection in benign tumors other than myxomas. Cardiac transplant was associated significantly with higher mortality rate (
P=
0.006). Overall mortality was associated to malignancy (
P
=0.0008), and adverse events during follow-up (
P
=0.005).
Conclusions—
Surgery for primary cardiac tumors in children has good early and long-term outcomes, with low recurrence rate. Rhabdomyomas are the most frequent surgical histotypes. Malignant tumors negatively affect early and late survival. Heart transplant is indicated when conservative surgery is not feasible. Lack of recurrence after partial resection of benign cardiac tumors indicates that a less risky tumor debulking is effective for a subset of histotypes such as rhabdomyomas and fibromas.
Collapse
Affiliation(s)
- Massimo A Padalino
- UOC Cardiochirurgia Pediatrica e Cardiopatie Congenite, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Centro Vincenzo Gallucci, Via Giustiniani 2, 35128 Padova, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
91
|
Demir HA, Ekici F, Yazal Erdem A, Emir S, Tunç B. Everolimus: a challenging drug in the treatment of multifocal inoperable cardiac rhabdomyoma. Pediatrics 2012; 130:e243-7. [PMID: 22732179 DOI: 10.1542/peds.2011-3476] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Primary cardiac tumors are rare in childhood. The most common of these are rhabdomyomas. Considering that rhabdomyomas often show spontaneous regression, close follow-up may be sufficient in hemodynamically stable cases. However, hemodynamically significant cardiac rhabdomyomas confer a risk of morbidity and mortality. Herein, we report a newborn infant with multifocal cardiac rhabdomyomas treated with everolimus. The optimal dose of the drug was 0.25 mg 2 times per day, 2 days per week. Patients with inoperable cardiac rhabdomyomas and with symptoms may be candidates for everolimus treatment.
Collapse
Affiliation(s)
- Haci Ahmet Demir
- Department of Pediatric Hematology/Oncology, Ankara Children’s Hematology Oncology Education and Research Hospital, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
92
|
Ogunkunle OO, Animashaun D. Intracardiac bronchogenic cyst in a 2-year-old Nigerian boy. BMJ Case Rep 2012; 2012:bcr.09.2011.4785. [PMID: 22605814 DOI: 10.1136/bcr.09.2011.4785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Primary cardiac tumours are rare in the paediatric age group. Bronchogenic cysts, although relatively rare, represent the most common cystic lesion of the mediastinum. Intracardiac bronchogenic cysts however, are extremely rare. The authors are unaware of any case previously reported in a Nigerian child and hence report the case of a 2-year-old boy for its rarity and interest. The boy was referred for evaluation of a cardiac murmur. Clinical, radiological and electrographic findings were suggestive of mild pulmonary stenosis or an atrial septal defect (ASD). 2-dimensional echocardiography however, revealed in addition to a small ASD, an intracardiac mass attached to the tricuspid valve. The mass was surgically removed and found on histology to be a bronchogenic cyst. Our experience highlights the importance of echocardiography in the evaluation of asymptomatic patients with cardiac murmurs, in whom a rare lesion might have otherwise been missed.
Collapse
|
93
|
Cardiac masses, part 2: key imaging features for diagnosis and surgical planning. AJR Am J Roentgenol 2011; 197:W842-51. [PMID: 22021531 DOI: 10.2214/ajr.11.6903] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objectives of this article are to discuss key radiologic features that differentiate primary and secondary cardiac masses. Clinical scenarios are included to highlight stepwise radiologic workup of tumors of the pericardium, epicardium, myocardium, valves, and chambers. The involvement of key cardiac anatomic structures will also be emphasized to determine resectability and guide surgical planning. CONCLUSION Multimodality imaging plays a pivotal role in diagnosis and surgical planning of cardiac masses. Clinical features, such as patient age, location, and imaging characteristics of the mass will determine the likely differential diagnosis. In addition to radiologic evaluation of the mass itself, involvement of valvular apparatus, extent of myocardial involvement, or presence of associated coronary artery involvement is necessary to determine resectability and surgical technique.
Collapse
|
94
|
Miyake CY, Del Nido PJ, Alexander ME, Cecchin F, Berul CI, Triedman JK, Geva T, Walsh EP. Cardiac Tumors and Associated Arrhythmias in Pediatric Patients, With Observations on Surgical Therapy for Ventricular Tachycardia. J Am Coll Cardiol 2011; 58:1903-9. [DOI: 10.1016/j.jacc.2011.08.005] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 07/15/2011] [Accepted: 08/09/2011] [Indexed: 10/16/2022]
|
95
|
Madueme P, Hinton R. Tuberous Sclerosis and Cardiac Rhabdomyomas: A Case Report and Review of the Literature. CONGENIT HEART DIS 2011; 6:183-7. [DOI: 10.1111/j.1747-0803.2011.00502.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
96
|
Patel J, Sheppard MN. Pathological study of primary cardiac and pericardial tumours in a specialist UK Centre: surgical and autopsy series. Cardiovasc Pathol 2010; 19:343-52. [DOI: 10.1016/j.carpath.2009.07.005] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 06/22/2009] [Accepted: 07/22/2009] [Indexed: 11/16/2022] Open
|
97
|
Golbar HM, Izawa T, Kuwamura M, Fujita D, Okamura K, Yamazaki R, Tagami Y, Sasai H, Yamate J. Cardiac hamartoma in a young squirrel monkey who died suddenly. Vet Pathol 2010; 48:970-4. [PMID: 20971945 DOI: 10.1177/0300985810386466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A case of cardiac hamartoma in a 2-month-old squirrel monkey is reported. The monkey showed a loss of appetite and died suddenly. Microscopically, an encapsulated nodular lesion was found at the right atrial wall. The lesion consisted of irregularly shaped, slender myocytes intermingled with a few fibroblasts and collagen fibers. Neither nuclear atypia nor inflammatory cell infiltrate was seen. The constituting cells had stratified striations in the cytoplasm and reacted immunohistochemically for desmin, indicating the nature of myocytes. Based on the above findings, a diagnosis of cardiac hamartoma was made. This is the first case of cardiac hamartoma in this species.
Collapse
Affiliation(s)
- H M Golbar
- Laboratory of Veterinary Pathology, Division of Veterinary Science, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Izumisano, Osaka, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
98
|
Animasahun AB, Kushimo OY, Fajuyile FA, Njokanma OF. Atrial myxoma in 2 nigerian children: case reports and review of the literature. World J Pediatr Congenit Heart Surg 2010; 1:397-9. [PMID: 23804895 DOI: 10.1177/2150135110381390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Myxomas are the most common primary cardiac tumors in adults. They are more common in the third to sixth decades of life but infrequent in the pediatric age group. Among pediatric patients, the most often affected patients are teenagers. Their presentation is often enigmatic because of vague constitutional findings. The vague and unusual symptomatology of cardiac myxomas often has led to delayed diagnosis or misdiagnosis in children and adolescents. We, therefore, present 2 cases among Nigerian children below adolescent age and also with vague symptomatology.
Collapse
|
99
|
Lee C, Kim SJ, Kim YM. Cardiac Fibroma in an Infant: Complete Resection After a Blalock-Taussig Shunt as Initial Palliation. Ann Thorac Surg 2010; 90:1011-4. [DOI: 10.1016/j.athoracsur.2010.02.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Revised: 01/29/2010] [Accepted: 02/09/2010] [Indexed: 10/19/2022]
|
100
|
Yinon Y, Chitayat D, Blaser S, Seed M, Amsalem H, Yoo SJ, Jaeggi ET. Fetal cardiac tumors: a single-center experience of 40 cases. Prenat Diagn 2010; 30:941-9. [DOI: 10.1002/pd.2590] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|