Primary cardiac tumors

Malignant fibrous histiocytoma complicating mitral valve replacement

A 67 year old woman developed a fatal febrile illness 8 years after mitral valve replacement for rheumatic valvular heart disease. The final disease persisted for 1 year and was characterized clinically by weakness, weight loss, congestive heart failure and multiple embolic events to the central nervous system and abdominal organs. The source of the emboli was a tumor, malignant fibrous histiocytoma of the left atrium, originating from the anulus fibrosus around the covered base of the prosthetic valve. This unique case suggests the possibility that chronic exposure to materials, such as Dacron, covering prosthetic valves may induce local malignant tumors.

Primary cardiac tumors: experience with 30 consecutive patients since the introduction of two-dimensional echocardiography

Experience with 30 consecutive patients who had a total of 32 primary cardiac tumors and who underwent two-dimensional echocardiographic examinations between January 1977 and June 1983 was reviewed. Most of the tumors were atrial myxomas (20 left and 4 right), and 30 were identified on echocardiography. Twenty-five patients, including 21 of 22 with atrial myxoma, underwent surgical resection on the basis of the echocardiographic examination, without preoperative angiocardiography. When the morphologic characteristics of the left atrial myxomas were studied statistically in relation to clinical abnormalities, large tumor size was most closely related to the number and type of associated clinical and laboratory abnormalities. The single exception was embolization, which correlated with echocardiographic tumor consistency. Since the introduction of two-dimensional echocardiography, the yearly incidence of cardiac tumor diagnosis at this clinic has increased several fold and the incidence of unexpected intraoperative diagnosis has been very low (one case). Echocardiography is the method of choice for clinical diagnosis. It has replaced angiocardiography for routine preoperative assessment, permits early diagnosis of cardiac neoplasms and provides insight into the pathophysiology of primary cardiac tumors.

Lymphomatous intracardiac mass detected by radionuclide ventriculography

A case of non-Hodgkin's lymphocytic lymphoma with cardiac involvement shown as an intracardiac-filling defect on the radionuclide ventriculogram is presented. The non-invasive diagnostic methods for cardiac lymphoma work-up are discussed. The known causes of cardiac-chamber filling defect(s) are reviewed.

Primary tumors of the heart: a review with emphasis on diagnosis and potential treatment modalities

Primary cardiac tumors, while uncommon, are not rare neoplasms. They occur in individuals of all ages. A variety of benign and malignant tumors has been described. Presenting signs and symptoms mimic numerous systemic and cardiac disease states. Echocardiography, catheterization, and nuclear magnetic resonance techniques are diagnostic tools available to the physician. Early diagnosis and surgical intervention are curative measures for many benign cardiac tumors. Malignant variants are uniformly unresponsive to treatment.

Approach in the management of atrial myxoma with long-term follow-up

Between 1972 and 1982, 9 patients underwent successful excision of atrial myxomas at the Upstate Medical Center. Eight patients had a left atrial myxoma and 1 a biatrial myxoma. There were 5 female and 4 male patients ranging from 16 to 63 years of age. Preoperative findings consisted of cerebral or peripheral emboli, congestive heart failure, and nonspecific symptoms. Diagnosis was confirmed by echocardiography and angiography in all but 1 patient. A biatrial operative approach was utilized in all patients except 1. Complete excision of the tumor with a cuff of normal tissue was performed. All heart chambers were carefully explored for presence of multicentric myxomas or tumor debris. There were no operative deaths or intraoperative embolizations. Follow-up has been 1 1/2 to 11 years. There has been 1 late noncardiac death. All patients underwent echocardiography postoperatively with no recurrence. The risk of intraoperative embolization and late recurrence is minimal with the biatriotomy technique. Two-dimensional echocardiography is extremely accurate in early diagnosis of myxomas and in the late follow-up of patients.

Multiple calcified thrombi (rocks) in the right ventricle

Large, organized right ventricular thrombi are rare. This report describes a 51 year old man with a history of recurrent pulmonary emboli treated with inferior vena cava ligation who subsequently developed multiple mobile calcified thrombi in the right ventricle. He was treated successfully by surgical resection. Unusual clinical presentation on admission consisted of a two component friction rub secondary to calcified masses rubbing against each other in systole and diastole. Cardiac catheterization showed a constrictive-restrictive pattern that persisted after surgery. The role of noninvasive studies in the diagnosis and long-term follow-up of the patient is emphasized.

Teratoma of the heart. A case report and review of the literature

The clinical manifestations and pathological features of an extremely rare cardiac tumour, a mature (benign) teratoma, in a 6 year-old girl are described. These are compared with those reported in the literature.