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Placidi S, Calcagni G, Lioncino M, Calvieri C, Maiolo S, Di Mambro C, Silvetti MS, Secinaro A, Adorisio R, Albanese S, Galletti L, Drago F. Type and dimensions can predict ventricular arrhythmias and cardiac death in primary benign cardiac tumors in children. Int J Cardiol 2024; 418:132599. [PMID: 39326704 DOI: 10.1016/j.ijcard.2024.132599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/31/2024] [Accepted: 09/23/2024] [Indexed: 09/28/2024]
Abstract
Despite being extremely rare in children, primary benign cardiac tumors can cause malignant ventricular arrhythmias (VA) or even sudden cardiac death. To assess the predictors of cardiovascular death and malignant VAs, we designed a retrospective single-center study enrolling paediatric patients. We defined as primary outcome a composite of cardiovascular death, sustained VT, ventricular fibrillation and rapid, symptomatic non-sustained VT. Our secondary endpoint was to assess the prevalence of clinically significant arrhythmias in our population. METHODS AND RESULTS: We fitted a multivariate Cox regression model to assess the predictors of the primary outcome. Over a period of 38 years, a total of 97 children were enrolled in the study. Among them, there were 73 rhabdomyomas, 13 fibromas, 3 myxomas, 3 teratomas, 1 lipoma, 2 haemangiomas and 2 fibroelastomas. Over a median follow up of 10.53 years, 16 patients met the primary outcome. Kaplan Meier unadjusted survival estimates showed that tumor dimensions larger than 2.3 cm and diagnosis of fibroma predicted worse outcomes compared with smaller tumors or other histotypes, (log rank p < 0.0002 and < 0.0001 respectively). In multivariate Cox proportional hazards analysis, diagnosis of fibroma and tumor dimensions were independently associated to the primary endpoint (HR: 5.06, 95 %CI (1.3-19); and 1.26 • (1.05-11), respectively). Clinically significant arrhythmias were reported in 24.5 % of the study population. CONCLUSIONS: Among paediatric primary cardiac tumors, type and dimensions may predict the hazard of malignant VAs and cardiac death.
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Affiliation(s)
- Silvia Placidi
- Paediatric Cardiology Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
| | - Giulio Calcagni
- Pediatric Cardiology and Cardiac Arrhythmias and Syncope Unit, Bambino Gesù Children's Hospital, IRCSS, 00146 Rome, Italy; European Reference Network for Low Prevalence and Rare Disease of the Heart- ERN Guard Heart, Italy.
| | - Michele Lioncino
- Pediatric Cardiology and Cardiac Arrhythmias and Syncope Unit, Bambino Gesù Children's Hospital, IRCSS, 00146 Rome, Italy; European Reference Network for Low Prevalence and Rare Disease of the Heart- ERN Guard Heart, Italy.
| | - Camilla Calvieri
- Paediatric Cardiology Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
| | - Stella Maiolo
- Pediatric Cardiology and Cardiac Arrhythmias and Syncope Unit, Bambino Gesù Children's Hospital, IRCSS, 00146 Rome, Italy; European Reference Network for Low Prevalence and Rare Disease of the Heart- ERN Guard Heart, Italy.
| | - Corrado Di Mambro
- Pediatric Cardiology and Cardiac Arrhythmias and Syncope Unit, Bambino Gesù Children's Hospital, IRCSS, 00146 Rome, Italy; European Reference Network for Low Prevalence and Rare Disease of the Heart- ERN Guard Heart, Italy.
| | - Massimo Stefano Silvetti
- Pediatric Cardiology and Cardiac Arrhythmias and Syncope Unit, Bambino Gesù Children's Hospital, IRCSS, 00146 Rome, Italy; European Reference Network for Low Prevalence and Rare Disease of the Heart- ERN Guard Heart, Italy.
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Bambino Gesù Children's Hospital, IRCSS, 00165 Rome, Italy.
| | - Rachele Adorisio
- Heart Failure, Transplant and Mechanical Cardiorespiratory Support Unit, Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy.
| | - Sonia Albanese
- Cardiac Surgery Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
| | - Lorenzo Galletti
- Cardiac Surgery Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
| | - Fabrizio Drago
- Pediatric Cardiology and Cardiac Arrhythmias and Syncope Unit, Bambino Gesù Children's Hospital, IRCSS, 00146 Rome, Italy; European Reference Network for Low Prevalence and Rare Disease of the Heart- ERN Guard Heart, Italy.
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2
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Murata H, Miyauchi Y, Nitta T, Sakamoto SI, Kunugi S, Ishii Y, Shimizu A, Fujimoto Y, Hayashi H, Yamamoto T, Yodogawa K, Maruyama M, Kaneko S, Hayashi H, Soejima K, Nogami A, Asai K, Shimizu W, Iwasaki YK. Electrophysiological and Histopathological Characteristics of Ventricular Tachycardia Associated With Primary Cardiac Tumors. JACC Clin Electrophysiol 2024; 10:43-55. [PMID: 37855769 DOI: 10.1016/j.jacep.2023.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/11/2023] [Accepted: 08/30/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Ventricular tachycardia (VT) associated with primary cardiac tumors (PCTs) originating from the ventricles is rare, but lethal, in young patients. OBJECTIVES This study aimed to clarify the mechanisms underlying primary cardiac tumor-related ventricular tachycardia (PCT-VT) and establish a therapeutic strategy for this form of VT. METHODS Among 67 patients who underwent surgery for VT at our institute between 1981 and 2020, 4 patients aged 1 to 34 years, including 3 males, showed PCT-VT (fibroma, 2; lipoma, 1; and hamartoma, 1), which was investigated using a combination of intraoperative electroanatomical mapping and histopathological studies. RESULTS All 4 patients developed electrical storms of sustained VTs refractory to multiple drugs and repetitive endocardial ablations. The VT mechanism was re-entry, and intraoperative electroanatomical mapping showed a centrifugal activation pattern originating from the border between the tumor and healthy myocardium, where fractionated potentials were detected during sinus rhythm. Histopathological studies of serial sections of specimens acquired from these areas revealed tumor infiltration into the surrounding myocardium with cell disorganization, exhibiting myocardial disarray. Several myocardia entrapped in the tumor edges contributed to the development and sustainment of re-entrant VT activation. In the 2 patients in whom complete resection was unfeasible, encircling cryoablation to entirely isolate the unresectable tumor was effective in suppressing VT occurrence. CONCLUSIONS The mechanism underlying PCT-VT involves re-entry localized at the tumor edges. Myocardial disarray associated with tumor infiltration is a substrate for this form of VT. Cryoablation along the border between the tumor and myocardium is a promising therapeutic option for unresectable PCT-VT.
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Affiliation(s)
- Hiroshige Murata
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan. https://twitter.com/Muratahiroshige
| | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | | | - Shinobu Kunugi
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yosuke Ishii
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yuhi Fujimoto
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroshi Hayashi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Teppei Yamamoto
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Shinji Kaneko
- Department of Cardiology, Toyota Kosei Hospital, Aichi, Japan
| | - Hidemori Hayashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University, Tokyo, Japan
| | - Akihiko Nogami
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
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3
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Meter M, Meter D, Ceprnja T, Perkovic D. Left Atrial Myxoma and Antiphospholipid Syndrome-A Case Report. Int J Angiol 2023; 32:269-272. [PMID: 37927839 PMCID: PMC10624530 DOI: 10.1055/s-0041-1740103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Cardiac myxoma (CM) is the most frequent type of primary cardiac neoplasm and is responsible for 58 to 80% of primary cardiac tumors. The antiphospholipid syndrome (APS) occurs most commonly in the systemic lupus erythematosus but it can be also found in other conditions. The coexistence of CM and APS is rarely described in the literature. We report an unusual case of the left atrial myxoma and concomitant APS in a female patient who presented with right-sided hemiplegia. Although rare, we must think about the CM in patients with a newly diagnosed APS and left atrial mass. Nevertheless, we must make a distinction from other possible cardiac structures, especially atrial thrombus. Transthoracic echocardiography is the most frequently used initial imaging modality to detect CM. The aim of this case report was to emphasize that additional imaging modalities and multidisciplinary approach are mandatory in making a proper diagnosis and to choose a further treatment strategy.
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Affiliation(s)
- Mijo Meter
- Department of Cardiology, University Hospital Centre Split, Split, Croatia
| | - Diana Meter
- Department of Rheumatology and Clinical Immunology, University Hospital Centre Split, Split, Croatia
| | - Toni Ceprnja
- Department of Pathology, Forensic Medicine and Cytology, University Hospital Centre Split, Split, Croatia
| | - Dijana Perkovic
- Department of Rheumatology and Clinical Immunology, University Hospital Centre Split, Split, Croatia
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4
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Shalata W, Massalha I, Ishay SY, Chernomordikova E, Jama AA, Rouvinov K, Dudnik Y, Yakobson A. Radiotherapy-Induced Atrial Myxoma: A Case Report and Literature Review. Life (Basel) 2023; 13:1585. [PMID: 37511961 PMCID: PMC10381263 DOI: 10.3390/life13071585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 06/29/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
In this particular case study, we present a 66-year-old male who was diagnosed with an atrial myxoma eight years after receiving treatment for non-small cell lung cancer. The patient underwent chemo-radiotherapy (mediastinal area) in 2012 to address stage III-A adenocarcinoma of the lung. During follow-up imaging in 2020, a left atrial mass displaying characteristic features of a cardiac myxoma was detected. Upon reviewing a computed tomographic (CT) scan from 2017 within the previously irradiated mediastinal region, the cardiac mass was retrospectively identified. The surgical excision of the cardiac mass was performed, and a subsequent pathological examination confirmed the diagnosis of myxoma. To the best of our knowledge, this is the first reported case of a left atrial myxoma in a patient previously treated for adenocarcinoma of the lung and the first instance of an atrial myxoma occurring in a site that had undergone prior radiation therapy.
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Affiliation(s)
- Walid Shalata
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben Gurion University, Beer Sheva 84105, Israel
| | - Ismaell Massalha
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben Gurion University, Beer Sheva 84105, Israel
| | - Shlomo Yaron Ishay
- Department of Cardio-Surgery, Soroka Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Elena Chernomordikova
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben Gurion University, Beer Sheva 84105, Israel
| | - Ashraf Abu Jama
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben Gurion University, Beer Sheva 84105, Israel
| | - Keren Rouvinov
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben Gurion University, Beer Sheva 84105, Israel
| | - Yulia Dudnik
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben Gurion University, Beer Sheva 84105, Israel
| | - Alexander Yakobson
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben Gurion University, Beer Sheva 84105, Israel
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5
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Polo López ML, Rey Lois J, Sánchez Pérez R, Ramchandani Ramchandani B, González Rocafort Á, Centella Hernández T, Lamas Hernández MJ, Salas Mera D, Verdú Sánchez C, Aroca Peinado Á. Operaciones inusuales en cirugía cardiaca infantil: resección de masas intracardiacas. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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6
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VR and 3D Printing for Pre-op Planning of Left Ventricular Myxoma in a Child. Ann Thorac Surg 2021; 113:e457-e460. [PMID: 34481800 DOI: 10.1016/j.athoracsur.2021.07.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/29/2021] [Indexed: 11/01/2022]
Abstract
We report a highly rare case of a large left ventricular myxoma with left ventricular outflow tract obstruction in a previously healthy, asymptomatic 7-year-old male. For preoperative planning, we used end-diastolic CT data to model the patient's cardiovascular structures and then generated a virtual reality (VR) model and a 3D-printed model. They helped the surgeon completely manage the details of the surgery. The mass was completely resected in one piece uneventfully. Histopathologic examination confirmed the diagnosis of myxoma. We believe that 3D technologies may be effective if the traditional modalities were insufficient in those rare, complex and heterogeneous cases.
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7
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Hasnie UA, Hasnie AA. Hiding Behind Atrial Fibrillation: A Rare Presentation of Atrial Myxoma. Am J Med 2021; 134:e193-e194. [PMID: 32956631 DOI: 10.1016/j.amjmed.2020.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Usman A Hasnie
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Ammar A Hasnie
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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8
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Abstract
Purpose of Review Cardiac masses frequently present significant diagnostic and therapeutic clinical challenges and encompass a broad set of lesions that can be either neoplastic or non-neoplastic. We sought to provide an overview of cardiac tumors using a cardiac chamber prevalence approach and providing epidemiology, imaging, histopathology, diagnostic workup, treatment, and prognoses of cardiac tumors. Recent Findings Cardiac tumors are rare but remain an important component of cardio-oncology practice. Over the past decade, the advances in imaging techniques have enabled a noninvasive diagnosis in many cases. Indeed, imaging modalities such as cardiac magnetic resonance, computed tomography, and positron emission tomography are important tools for diagnosing and characterizing the lesions. Although an epidemiological and multimodality imaging approach is useful, the definite diagnosis requires histologic examination in challenging scenarios, and histopathological characterization remains the diagnostic gold standard. Summary A comprehensive clinical and multimodality imaging evaluation of cardiac tumors is fundamental to obtain a proper differential diagnosis, but histopathology is necessary to reach the final diagnosis and subsequent clinical management.
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9
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Mondal S, Jubar J, Kostibas MP. Near Total Occlusion of Right Ventricle by Cardiac Mass. J Cardiothorac Vasc Anesth 2018; 33:2085-2090. [PMID: 30685150 DOI: 10.1053/j.jvca.2018.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Indexed: 11/11/2022]
Abstract
The incidence of primary cardiac tumors is very rare (0.02%) with the majority being benign. Angiosarcoma is the most common malignant cardiac tumor. However, regardless of the histological nature of cardiac tumors, they can cause life-threatening mechanical obstruction. We present a case of urgent surgical removal of a right ventricular (RV) mass. Echocardiography was instrumental for confirmation of the diagnosis, delineation of the anatomical extent of the tumor, evaluation for associated structural involvement and assessment of repair along with constant hemodynamic monitoring.
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Affiliation(s)
- Samhati Mondal
- Department of Anesthesiology, University of Maryland Medical Center, Baltimore, MD.
| | - John Jubar
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Megan P Kostibas
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
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10
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Bernatchez J, Gaudreault V, Vincent G, Rheaume P. Left Atrial Myxoma Presenting as an Embolic Shower: A Case Report and Review of Literature. Ann Vasc Surg 2018; 53:266.e13-266.e20. [DOI: 10.1016/j.avsg.2018.04.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/12/2018] [Accepted: 04/20/2018] [Indexed: 12/29/2022]
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11
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Maleszewski JJ, Bois MC, Bois JP, Young PM, Stulak JM, Klarich KW. Neoplasia and the Heart. J Am Coll Cardiol 2018; 72:202-227. [DOI: 10.1016/j.jacc.2018.05.026] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 12/17/2022]
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Abstract
Primary cardiac tumors are extremely rare. In one study, incidence was reported being less than 0.1%. The purpose of this case report is to review different presentations of cardiac myxoma. A 34-year-old female with past medical history of drug abuse was brought into the emergency department (ED) after a motor vehicle collision. She was found to have multiple fractures with a hypodense mass in the left atrium. Further evaluation showed a left atrial myxoma. The patient underwent myxoma resection. The clinical appearance of myxoma varies from non-specific to life-threatening complications, such as stroke, acute heart failure, or even sudden death. A surgical resection is the treatment of choice for cardiac myxomas.
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Affiliation(s)
- Rizwan Ali
- Internal Medicine, Rapides Regional Hospital, Alexandria, USA
| | - Arooj Tahir
- Internal Medicine, Rapides Regional Hospital, Alexandria, USA
| | | | - Syed B Rizvi
- Cardiology Department, Rapides Regional Hospital, Alexandria, USA
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13
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Mo R, Mi L, Zhou Q, Wang D. Outcomes of surgical treatment in 115 patients with primary cardiac tumours: a 15-year experience at a single institution. J Thorac Dis 2017; 9:2935-2941. [PMID: 29221265 DOI: 10.21037/jtd.2017.08.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Primary cardiac tumours are rare, and few studies have examined large samples. The aim of this study was to review a single institution's 15 years of experience with primary cardiac tumours. Methods We conducted a retrospective analysis of 119 consecutive patients admitted to the Nanjing Drum Tower Hospital from April 2002 to January 2017. Five patients declined surgery due to illness or for financial reasons, and one patient underwent a second operation due to tumour recurrence 10 years after the first operation. In total, 115 patients underwent surgery. The surgeons used median sternotomy and a right atrial approach to complete the gross total resection. The patients were separated into three groups according to their tumour pathology (myxomas, other benign tumours, or malignant tumours). A total of 84 patients were followed up for an average of 34.8±31.2 months (range 2-141 months). Results The sites of the cardiac tumours included the left atrium (n=93, 80.1%), right atrium (n=14, 14.0%), left ventricle (n=2, 1.7%), valves (n=7, 6.0%), and other sites (n=1, 0.8%). According to the postoperative pathology, 99 (86.0%) tumours were classified as myxomas, 8 (7.0%) were other types of benign tumours, and 8 (7.0%) were malignant tumours. Patients with malignant tumours had a longer surgical time (P=0.035) and postoperative hospitalization time (P=0.009). Patients with myxoma tumours exhibited better 5-year survival than patients with malignant tumours (95.7% vs. 57.1%, P<0.001). Conclusions In the Chinese population, the incidence of primary cardiac tumours is mainly attributable to myxomas. Gross total resection is a safe and effective treatment for both benign and malignant tumours. Long-term survival is satisfactory for benign tumours but low for malignant tumours, and a risk of recurrence exists. Postoperative chemotherapy or radiotherapy may be needed to achieve better outcomes.
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Affiliation(s)
- Ran Mo
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School of Nanjing University, Nanjing 210008, China
| | - Lin Mi
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School of Nanjing University, Nanjing 210008, China
| | - Qing Zhou
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School of Nanjing University, Nanjing 210008, China
| | - Dongjin Wang
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School of Nanjing University, Nanjing 210008, China
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Mkalaluh S, Szczechowicz M, Torabi S, Dib B, Sabashnikov A, Mashhour A, Karck M, Weymann A. Surgery for Cardiac Papillary Fibroelastoma: A 12-Year Single Institution Experience. Med Sci Monit Basic Res 2017; 23:258-263. [PMID: 28706178 PMCID: PMC5523956 DOI: 10.12659/msmbr.904881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We reviewed our clinical experience with cardiac papillary fibroelastoma from 2005 to 2017. The objective of this study was to investigate the clinical and operative data, as well as the early survival rate and immediate postoperative complications. MATERIAL AND METHODS We performed a retrospective analysis of 11 patients (eight males and three females) who underwent resection of cardiac papillary fibroelastoma in our institution. RESULTS Mean age at tumor diagnosis was 60±14 years. The mean dimension of the tumor was 14±11 mm. The most common symptoms were dyspnea, palpitation, and angina pectoris, while one patient had recurrent fever attacks and another patient had a transient ischemic attack. Two patients had concomitant malignant tumors (cervical and colon carcinoma) and another two had concomitant benign neoplasms (liver cyst and thyroid adenoma). Bypass and cross clamp times were 77±32 minutes and 54±18 minutes, respectively. The tumors were found predominantly on cardiac valves (n=7). In eight cases, only tumor extirpation was performed, whereas in the other three cases, the valves had to be replaced. The mean intensive care unit length of stay was 1.1±0.3 days and there was no in-hospital mortality. All patients were alive at one-year follow-up and the survival rate was 91% in the mean follow-up period of 4.15 years. CONCLUSIONS The surgical treatment of cardiac papillary fibroelastoma was curative and safe. Thus, potential complications such as embolization or mechanical irritation of the valves can be avoided without high surgical risk.
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Affiliation(s)
- Sabreen Mkalaluh
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Marcin Szczechowicz
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Saeed Torabi
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Bashar Dib
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Ahmed Mashhour
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany.,Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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15
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Bastidas-Cuéllar ML, Vallejo Mondragón E, Valencia Salazar Á, Madrid A. Tumor intracardiaco en paciente adolescente. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2016.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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16
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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.
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Lee KS, Kim GS, Jung Y, Jeong IS, Na KJ, Oh BS, Ahn BH, Oh SG. Surgical resection of cardiac myxoma-a 30-year single institutional experience. J Cardiothorac Surg 2017; 12:18. [PMID: 28347356 PMCID: PMC5368917 DOI: 10.1186/s13019-017-0583-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 03/21/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Primary cardiac tumors are rare and myxoma constitutes the majority. The present study summarizes our 30-year clinical outcomes of surgical myxoma resection. METHODS Between January 1986 and December 2015, 93 patients (30 men, 63 women; mean age, 54.7 ± 16.6 years) underwent surgical myxoma resection. The most common origin site was the left atrium. Surgery was performed via a biatrial approach in 74.2%, atrial septotomy through right atriotomy in 17.2%, and left atriotomy only in 8.6%. Mean myxoma size based on longest length was 4.73 ± 1.92 cm (range, 1.2-11.0 cm). RESULTS The mean follow-up duration was 9.9 ± 7.8 years (range, 0-29 years). In-hospital mortality was 3.2%. The most common postoperative complication was atrial fibrillation (4.3%). The 5-, 10-, and 30-year survival rates were 92.9%, 87.2%, and 75.5%, respectively. Recurrence occurred in two patients (2.1%), which were detected at 20 and 79 months after the first surgery, respectively. CONCLUSIONS Long-term survival after myxoma resection was excellent and recurrence was rare. Based on our experience, surgical method did not affect the outcome.
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Affiliation(s)
- Kyo Seon Lee
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42, Jebong-ro, Dong-gu, Gwangju, 15772, South Korea
| | - Gwan Sic Kim
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42, Jebong-ro, Dong-gu, Gwangju, 15772, South Korea
| | - Yochun Jung
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42, Jebong-ro, Dong-gu, Gwangju, 15772, South Korea
| | - In Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42, Jebong-ro, Dong-gu, Gwangju, 15772, South Korea
| | - Kook Joo Na
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42, Jebong-ro, Dong-gu, Gwangju, 15772, South Korea
| | - Bong Suk Oh
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42, Jebong-ro, Dong-gu, Gwangju, 15772, South Korea
| | - Byung Hee Ahn
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42, Jebong-ro, Dong-gu, Gwangju, 15772, South Korea
| | - Sang Gi Oh
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42, Jebong-ro, Dong-gu, Gwangju, 15772, South Korea.
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18
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Tarelo-Saucedo JM, Peñaloza-Guadarrama M, Villela-Caleti J, García-Cruz A, Arizmendi-Monroy DK, Reynada-Torres JL, Martinez-Ramirez L. [Surgical results and monitoring of postoperative atrial myxomas]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 86:35-40. [PMID: 26525520 DOI: 10.1016/j.acmx.2015.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 09/08/2015] [Accepted: 09/14/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To analyze the casuistics of left atrial myxoma with emphasis on results and follow-up. METHOD We reviewed the clinical records of patients operated in the Hospital Cardiac Myxomas South Central High Specialty (HCSAE) of PEMEX in the last 7 years, with an emphasis on results and follow-up. RESULTS The analysis showed 10 patients, of whom 60% were female and 40% male, with ages from 12 to 76 years, with a mean age of 50 years. In the clinical characteristics of patients predominated dyspnea in 90%, followed by fatigue (80%) and chest pain (60%). The incidence was 90% for the left atrium and 10% for the right atrium, had tumors less than 3cm to up to over 10cm (average of 6 to 7cm). The pathology report was myxoma in the 100% of cases, the morbidity and early mortality was 0%, with a mean hospital stay of 6 days, and a patient of 12 years of age recurred and underwent surgery five months later. The 5-year survival was 100%. CONCLUSIONS The incidence of myxomas is well known for rare presentation, the experience in this national medical center is one patient for every 350 operations, one case per year with no mortality and excellent survival.
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Affiliation(s)
- Juan M Tarelo-Saucedo
- Servicio de Cirugía Cardiovascular, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, México D.F., México.
| | - Mario Peñaloza-Guadarrama
- Servicio de Cirugía Cardiovascular, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, México D.F., México
| | - Jorge Villela-Caleti
- Servicio de Cirugía Cardiovascular, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, México D.F., México
| | - Adriana García-Cruz
- Servicio de Anestesia, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, México D.F., México
| | - Dulce K Arizmendi-Monroy
- Servicio de Anestesia, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, México D.F., México
| | - Jose L Reynada-Torres
- Servicio de Anestesia, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, México D.F., México
| | - Leonel Martinez-Ramirez
- Servicio de Cardiología, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, México D.F., México
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19
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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.
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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
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20
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Hoey ETD, Shahid M, Ganeshan A, Baijal S, Simpson H, Watkin RW. MRI assessment of cardiac tumours: part 1, multiparametric imaging protocols and spectrum of appearances of histologically benign lesions. Quant Imaging Med Surg 2014; 4:478-88. [PMID: 25525581 DOI: 10.3978/j.issn.2223-4292.2014.11.23] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 11/19/2014] [Indexed: 01/06/2023]
Abstract
Cardiac magnetic resonance imaging (MRI) is the reference standard technique for assessment and characterization of a suspected cardiac tumour. It provides an unrestricted field of view, high temporal resolution and non-invasive tissue characterization based on multi-parametric assessment of the chemical micro-environment. MRI exploits differences in hydrogen proton density in conjunction with T1 and T2 relaxation properties of different tissues to help differentiation normal from abnormal and benign from malignant lesions. In this article we review specific cardiac MRI techniques, tumour protocol design and the appearance of the spectrum of histologically benign tumours.
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Affiliation(s)
- Edward T D Hoey
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Muhammad Shahid
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Arul Ganeshan
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Shobhit Baijal
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Helen Simpson
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Richard W Watkin
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
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22
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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]
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23
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Qin C, Chen L, Wen RG, Xiao YB. Total correction of tetralogy of Fallot associated with rhabdomyoma in the right ventricle. J Thorac Cardiovasc Surg 2010; 141:e20-2. [PMID: 21167515 DOI: 10.1016/j.jtcvs.2010.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 09/07/2010] [Accepted: 10/16/2010] [Indexed: 11/27/2022]
Affiliation(s)
- Chuan Qin
- Department of Cardiovascular Surgery, Xin Qiao Hospital, the Third Military Medical University, Chong Qing, China
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ElBardissi AW, Dearani JA, Daly RC, Mullany CJ, Orszulak TA, Puga FJ, Schaff HV. Embolic Potential of Cardiac Tumors and Outcome After Resection. Stroke 2009; 40:156-62. [DOI: 10.1161/strokeaha.108.525709] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew W. ElBardissi
- From the Department of Surgery (A.W.E.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass; and the Division of Cardiovascular Surgery (A.W.E., J.A.D., R.C.D., C.J.M., T.A.O., F.J.P., H.V.S.), Mayo Clinic and Foundation, Rochester, Minn
| | - Joseph A. Dearani
- From the Department of Surgery (A.W.E.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass; and the Division of Cardiovascular Surgery (A.W.E., J.A.D., R.C.D., C.J.M., T.A.O., F.J.P., H.V.S.), Mayo Clinic and Foundation, Rochester, Minn
| | - Richard C. Daly
- From the Department of Surgery (A.W.E.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass; and the Division of Cardiovascular Surgery (A.W.E., J.A.D., R.C.D., C.J.M., T.A.O., F.J.P., H.V.S.), Mayo Clinic and Foundation, Rochester, Minn
| | - Charles J. Mullany
- From the Department of Surgery (A.W.E.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass; and the Division of Cardiovascular Surgery (A.W.E., J.A.D., R.C.D., C.J.M., T.A.O., F.J.P., H.V.S.), Mayo Clinic and Foundation, Rochester, Minn
| | - Thomas A. Orszulak
- From the Department of Surgery (A.W.E.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass; and the Division of Cardiovascular Surgery (A.W.E., J.A.D., R.C.D., C.J.M., T.A.O., F.J.P., H.V.S.), Mayo Clinic and Foundation, Rochester, Minn
| | - Francisco J. Puga
- From the Department of Surgery (A.W.E.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass; and the Division of Cardiovascular Surgery (A.W.E., J.A.D., R.C.D., C.J.M., T.A.O., F.J.P., H.V.S.), Mayo Clinic and Foundation, Rochester, Minn
| | - Hartzell V. Schaff
- From the Department of Surgery (A.W.E.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass; and the Division of Cardiovascular Surgery (A.W.E., J.A.D., R.C.D., C.J.M., T.A.O., F.J.P., H.V.S.), Mayo Clinic and Foundation, Rochester, Minn
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