1
|
Beroukhim RS, Geva T, Del Nido P, Sleeper LA, Lu M, Muter A, Harrild DM, Walsh EP, Nathan M. Risk Factors for Left Ventricular Dysfunction Following Surgical Management of Cardiac Fibroma. Circ Cardiovasc Imaging 2021; 14:e011748. [PMID: 33517672 DOI: 10.1161/circimaging.120.011748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Surgical resection of cardiac fibromas in children reduces hemodynamic and arrhythmia burden; however, little is known about postoperative left ventricular (LV) function. We aimed to evaluate factors associated with postoperative LV dysfunction. METHODS In this retrospective observational cohort study, imaging data were reviewed from 41 patients who had undergone surgical resection of a cardiac fibroma. Tumor volume was indexed to body surface area (tumor volume index). Right ventricular tumors were excluded from analysis of postoperative ventricular function. Postoperative regional wall motion abnormality score was defined as number of wall segments with regional wall motion abnormality, and LV dysfunction was defined as LV ejection fraction <50%. Cardiovascular magnetic resonance-derived strain was low if <5%ile by previously published normative data. RESULTS Of 41 patients who underwent resection at a median age of 2.1 years (range, 0.5-19), 37 fibromas were in the LV, (29 free wall and 8 septal), and 4 in the right ventricle. Preoperative median tumor volume index was 66 mL/m2 (range, 11-376). Of 37 patients with LV tumors, younger patients had larger tumor volume index and higher grades of preoperative mitral regurgitation (P<0.001). Larger tumor volume index correlated with higher postoperative regional wall motion abnormality score (P<0.001). By paired pre- and post-operative cardiovascular magnetic resonance (n=14), LV end-diastolic volume increased (mean 76 versus 101 mL/m2, P=0.011), with decreased LV ejection fraction (mean 60% versus 55%, P=0.014), a higher prevalence of low global circumferential strain (36% versus 64%, P=0.045), and decreased cardiac index (mean 4.8 versus 3.9 L/[min·m2], P=0.039). More than mild preoperative mitral regurgitation was the only independent predictor of predischarge LV dysfunction (odds ratio, 22 [95% CI, 2.8-179], P=0.008). CONCLUSIONS Surgical resection of LV fibroma is associated with regional wall motion abnormality, increased LV volume, and reduced systolic function. Children with significant preoperative mitral regurgitation are at highest risk for LV dysfunction and warrant ongoing close surveillance.
Collapse
Affiliation(s)
- Rebecca S Beroukhim
- Department of Cardiology (R.S.B., T.G., L.A.S., M.L., A.M., D.M.H., E.P.W.), Boston Children's Hospital.,Harvard Medical School, Boston, MA (R.S.B., T.G., P.d.N., L.A.S., D.M.H., E.P.W., M.N.)
| | - Tal Geva
- Department of Cardiology (R.S.B., T.G., L.A.S., M.L., A.M., D.M.H., E.P.W.), Boston Children's Hospital.,Harvard Medical School, Boston, MA (R.S.B., T.G., P.d.N., L.A.S., D.M.H., E.P.W., M.N.)
| | - Pedro Del Nido
- Department of Cardiovascular Surgery (P.d.N., M.N.), Boston Children's Hospital.,Harvard Medical School, Boston, MA (R.S.B., T.G., P.d.N., L.A.S., D.M.H., E.P.W., M.N.)
| | - Lynn A Sleeper
- Department of Cardiology (R.S.B., T.G., L.A.S., M.L., A.M., D.M.H., E.P.W.), Boston Children's Hospital.,Harvard Medical School, Boston, MA (R.S.B., T.G., P.d.N., L.A.S., D.M.H., E.P.W., M.N.)
| | - Minmin Lu
- Department of Cardiology (R.S.B., T.G., L.A.S., M.L., A.M., D.M.H., E.P.W.), Boston Children's Hospital
| | - Angelika Muter
- Department of Cardiology (R.S.B., T.G., L.A.S., M.L., A.M., D.M.H., E.P.W.), Boston Children's Hospital
| | - David M Harrild
- Department of Cardiology (R.S.B., T.G., L.A.S., M.L., A.M., D.M.H., E.P.W.), Boston Children's Hospital.,Harvard Medical School, Boston, MA (R.S.B., T.G., P.d.N., L.A.S., D.M.H., E.P.W., M.N.)
| | - Edward P Walsh
- Department of Cardiology (R.S.B., T.G., L.A.S., M.L., A.M., D.M.H., E.P.W.), Boston Children's Hospital.,Harvard Medical School, Boston, MA (R.S.B., T.G., P.d.N., L.A.S., D.M.H., E.P.W., M.N.)
| | - Meena Nathan
- Department of Cardiovascular Surgery (P.d.N., M.N.), Boston Children's Hospital.,Harvard Medical School, Boston, MA (R.S.B., T.G., P.d.N., L.A.S., D.M.H., E.P.W., M.N.)
| |
Collapse
|
2
|
Beroukhim RS, Prakash A, Buechel ERV, Cava JR, Dorfman AL, Festa P, Hlavacek AM, Johnson TR, Keller MS, Krishnamurthy R, Misra N, Moniotte S, Parks WJ, Powell AJ, Soriano BD, Srichai MB, Yoo SJ, Zhou J, Geva T. Characterization of cardiac tumors in children by cardiovascular magnetic resonance imaging: a multicenter experience. J Am Coll Cardiol 2011; 58:1044-54. [PMID: 21867841 DOI: 10.1016/j.jacc.2011.05.027] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 04/26/2011] [Accepted: 05/03/2011] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to report the results of an international multicenter experience of cardiac magnetic resonance imaging (MRI) evaluation of cardiac tumors in children, each with histology correlation or a diagnosis of tuberous sclerosis, and to determine which characteristics are predictive of tumor type. BACKGROUND Individual centers have relatively little experience with diagnostic imaging of cardiac tumors in children, because of their low prevalence. The accuracy of cardiac MRI diagnosis on the basis of a pre-defined set of criteria has not been tested. METHODS An international group of pediatric cardiac imaging centers was solicited for case contribution. Inclusion criteria comprised: 1) age at diagnosis ≤18 years; 2) cardiac MRI evaluation of cardiac tumor; and 3) histologic diagnosis or diagnosis of tuberous sclerosis. Data from the cardiac MRI images were analyzed for mass characteristics. On the basis of pre-defined cardiac MRI criteria derived from published data, 3 blinded investigators determined tumor type, and their consensus diagnoses were compared with histologic diagnoses. RESULTS Cases (n = 78) submitted from 15 centers in 4 countries had the following diagnoses: fibroma (n = 30), rhabdomyoma (n = 14), malignant tumor (n = 12), hemangioma (n = 9), thrombus (n = 4), myxoma (n = 3), teratoma (n = 2), and paraganglioma, pericardial cyst, Purkinje cell tumor, and papillary fibroelastoma (n = 1, each). Reviewers who were blinded to the histologic diagnoses correctly diagnosed 97% of the cases but included a differential diagnosis in 42%. Better image quality grade and more complete examination were associated with higher diagnostic accuracy. CONCLUSIONS Cardiac MRI can predict the likely tumor type in the majority of children with a cardiac mass. A comprehensive imaging protocol is essential for accurate diagnosis. However, histologic diagnosis remains the gold standard, and in some cases malignancy cannot be definitively excluded on the basis of cardiac MRI images alone.
Collapse
Affiliation(s)
- Rebecca S Beroukhim
- Department of Cardiology, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|