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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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Gikandi A, Chiu P, Secor J, Nathan M, O'Leary E, Walsh E, Geva T, Beroukhim R, Del Nido P. Surgical debulking of large ventricular fibromas in children. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00444-6. [PMID: 38802044 DOI: 10.1016/j.jtcvs.2024.05.013] [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: 04/27/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE This study aims to provide an update on the clinical presentation, diagnostic workup, operative strategies, and midterm outcomes in children undergoing ventricular fibroma resection. METHODS Single-center, retrospective cohort study of patients undergoing ventricular fibroma resection between 2000 and 2023. RESULTS Among 52 patients, median age at surgery was 2.0 years (interquartile range, 0.8-4.6) and median tumor volume index was 69 mL/m2 (interquartile range, 49-169). Tumor distorted the atrioventricular valve/subvalvar apparatus in 30 patients (58%) and abutted major epicardial coronary arteries in 41 patients (79%). Surgery was indicated for arrythmia (n = 45, 86%), symptoms (n = 14, 27%), or hemodynamic compromise (n = 11, 21%). Tumor was debulked in 34 patients (65%), including the last 21 patients. Concomitant atrioventricular valvuloplasty was performed in 18 patients and ventricular cavity closure in 15 patients (29%). During a median follow-up of 2.4 years (interquartile range, 0.8-6.2), there was no mortality, cardiac arrests, heart transplants, or single ventricle palliation. The 15-year risk of reoperation and clinical ventricular tachycardia/fibrillation was 6.7% (95% CI, 0-14.3) and 2.4% (95% CI, 0-7.2), respectively. On latest imaging, pre- and postdebulking left ventricular ejection fraction did not significantly differ (P = .069), whereas no patients had signs of outflow tract obstruction, inflow tract obstruction, or moderate or greater atrioventricular valve regurgitation. CONCLUSIONS Large ventricular fibromas can be resected safely with appropriate surgical planning and an emphasis on debulking. Most children maintain left ventricular function and remain free of recurrent ventricular arrhythmias at follow-up. Extended follow-up is warranted to understand whether patients remain at risk for scar-based ventricular arrhythmias in the future.
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Affiliation(s)
- Ajami Gikandi
- Division of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Peter Chiu
- Division of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Jordan Secor
- Division of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Meena Nathan
- Division of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Edward O'Leary
- Division of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Edward Walsh
- Division of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Tal Geva
- Division of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Rebecca Beroukhim
- Division of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Pedro Del Nido
- Division of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
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3
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Margarint I, Sorescu A, Popescu M, Robu M, Untaru O, Filip C. A Unique Case of a Gigantic Left Ventricular Myxoma Resulting in Embolic Acute Lower Limb Ischemia in a Pediatric Patient. J Clin Med 2024; 13:2189. [PMID: 38673460 PMCID: PMC11050862 DOI: 10.3390/jcm13082189] [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: 03/18/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The presence of a primary cardiac tumor in a pediatric patient is a rare echocardiographic finding. CASE REPORT We report the case of an 11-year-old female patient with multiple peripheral embolisms, due to a gigantic left ventricular tumor, with a unique echocardiographic appearance. The patient was referred to the emergency department due to acute pain and loss of sensitivity in both of her legs. Past medical history was significant for acute lymphoblastic leukemia. Upon physical examination, suspicion of bilateral lower leg ischemia was raised. Doppler arterial ultrasound of both legs confirmed the suspicion mentioned above, as the right lower extremity suffered from partial arterial occlusion of the external iliac artery and total occlusion of the femoral arteries. Meanwhile, in the left lower extremity, the occlusion was localized in the proximal tibio-peroneal artery. Cardiac sonography revealed a massive, mobile, left ventricular intracavitary mass. Aside from its large dimensions (6.3 cm by 3 cm), its aspect was striking as well as it had very mobile and friable edges. Emergency bilateral endarterectomy and excision of the left ventricular tumor were performed alongside systemic anticoagulant therapy, with excellent results, as no tumoral residual masses could be seen in the left ventricle, and the arterial blood flow was restored completely in both lower extremities. The histopathological aspect of the excised masses was that of a myxoma. The patient recovered well after surgery and was discharged on postoperative day 14. CONCLUSION Despite only a handful of cases of cardiac myxomas being reported due to their rarity in the pediatric population, clinical presentation with peripheric embolism triggered a high index of suspicion of embolic mechanism in our patient and prompted a rapid assessment and successful management.
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Affiliation(s)
- Irina Margarint
- Faculty of Medicine, Carol Davila University of Medicine, and Pharmacy, 050474 Bucharest, Romania; (I.M.); (C.F.)
- Department of Cardiac Surgery, Emergency Clinical Hospital for Children “Maria Skłodowska Curie”, 077120 Bucharest, Romania;
| | - Adelina Sorescu
- Faculty of Medicine, Carol Davila University of Medicine, and Pharmacy, 050474 Bucharest, Romania; (I.M.); (C.F.)
- Department of Pediatric Cardiology, Emergency Clinical Hospital for Children “Maria Skłodowska Curie”, 077120 Bucharest, Romania
| | - Monica Popescu
- Department of Anesthesia and Intensive Care, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania;
| | - Mircea Robu
- Faculty of Medicine, Carol Davila University of Medicine, and Pharmacy, 050474 Bucharest, Romania; (I.M.); (C.F.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Olga Untaru
- Department of Cardiac Surgery, Emergency Clinical Hospital for Children “Maria Skłodowska Curie”, 077120 Bucharest, Romania;
| | - Cristina Filip
- Faculty of Medicine, Carol Davila University of Medicine, and Pharmacy, 050474 Bucharest, Romania; (I.M.); (C.F.)
- Department of Pediatric Cardiology, Emergency Clinical Hospital for Children “Maria Skłodowska Curie”, 077120 Bucharest, Romania
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Jawad A, Hannouneh ZA, Salame H, Jaber R, Eid N. Solitary atrial Rhabdomyoma in an infant with tuberous sclerosis: a case report and review of the literature. BMC Cardiovasc Disord 2023; 23:597. [PMID: 38062408 PMCID: PMC10701948 DOI: 10.1186/s12872-023-03639-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Despite its rare incidence of 1/40,000, fetal cardiac rhabdomyoma (CR) represents the prevailing type of benign cardiac fetal tumors, which commonly affects the ventricles. Fetal CRs rarely occur in the right atrium. Thus, the presentation of atrial fibrillation and premature atrial contractions (PAC) due to a solitary cardiac rhabdomyoma is an extremely rare scenario. Our literature review found that only 2% (1 out of 61) of rhabdomyoma cases were found in the right atrium. The majority of fetal cardiac rhabdomyomas are associated with tuberous sclerosis complex (TSC). CASE PRESENTATION A 7-day-old male neonate presented with arrhythmias and an atrial mass for further evaluation. Echocardiography revealed a hyperechoic, round, uniform right atrial mass (25 mm). An abdominal and testicular ultrasound showed multiple thin-walled cortical cysts in both kidneys and a scrotal hydrocele, respectively. His laboratory workup was insignificant except for hypomagnesemia. Electrocardiography revealed junctional rhythm and PACs with wave distortions. A brain magnetic resonance imaging scan revealed multiple subependymal lesions on the frontal and occipital horns of the lateral ventricles. These findings (Fig. 1), along with a family history of TSC, confirmed the diagnosis of TSC with associated CR. The patient was treated symptomatically with an anti-convulsant and monitored with regular follow-ups. Surgical resection was not required. CONCLUSION Despite CR's predominance in the ventricles, a diagnosis of rhabdomyoma should be kept in mind in the presence of a solitary atrial mass and PACs. Physicians should evaluate systemic findings related to TSC and provide appropriate follow-up and family screening. Surgical resection is not always required, and symptom management can be achieved through medical treatment alone.
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Affiliation(s)
- Ali Jawad
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Zein Alabdin Hannouneh
- Faculty of Medicine, Al Andalus University for Medical Sciences, Tartus, Syrian Arab Republic.
| | - Hadi Salame
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Rida Jaber
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Nader Eid
- Neonatology Intensive Care department, Damascus University Children Hospital, Damascus, Syrian Arab Republic
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Sevinc Sengul F, Yildiz O, Deveci M, Ayyildiz P, Guzeltas A. From cyanosis to diagnosis: A case report on right atrial fibroma in a pediatric patient. Echocardiography 2023; 40:1107-1111. [PMID: 37615629 DOI: 10.1111/echo.15674] [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: 06/24/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
A 3-year-old female patient presented with symptoms of cyanosis and intermittent eyelid edema, leading to the discovery of a lobulated mass in the right atrium, obstructing the superior vena cava. Despite the inability to entirely remove the mass due to its origins in the right atrium myocardium and its extension towards the sinoatrial node, successful surgical intervention and subsequent histopathological evaluation identified the mass as a fibroma, and postoperative symptoms were significantly alleviated.
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Affiliation(s)
- Fatma Sevinc Sengul
- Department of Pediatric Cardiology, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Okan Yildiz
- Department of Pediatric Cardiac Surgery, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Deveci
- Department of Pediatric Cardiology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Pelin Ayyildiz
- Department of Pediatric Cardiology, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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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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7
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Boudreaux J, Lara D, Hines M. Right ventricular myxoma in a child causing right ventricular outflow tract obstruction. Cardiol Young 2022; 33:1-3. [PMID: 35450546 DOI: 10.1017/s1047951122001214] [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] [Indexed: 11/07/2022]
Abstract
Primary cardiac tumours are uncommon in the paediatric population, accounting for fewer than 0.5% of paediatric cases of cardiac disease. Right ventricular tumours, including myxomas, are particularly rare and may be asymptomatic or demonstrate varying degrees of cardiac dysfunction based on the location and size of the tumour, inducing conduction abnormalities, syncope, embolism, and potentially, sudden death. We report a rare case of right ventricular myxoma causing severe right ventricular outflow tract obstruction and surgical intervention in a paediatric patient.
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Affiliation(s)
| | - Diego Lara
- Ochsner Health Center for Children, New Orleans, LA, USA
| | - Michael Hines
- Ochsner Health Center for Children, New Orleans, LA, USA
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8
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Qian T, Wu Z, Yang Y, Xie L, Yin N, Lu T, Huang C, Yang H. Surgery for Primary Cardiac Tumors in Children: Successful Management of Large Fibromas. Front Cardiovasc Med 2022; 9:808394. [PMID: 35321111 PMCID: PMC8934860 DOI: 10.3389/fcvm.2022.808394] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Pediatric primary cardiac tumors (PCTs) are rare. Its clinical features and prognoses are not well defined. The management of asymptomatic patients with cardiac fibromas remains controversial. Objective We aimed to examine our experience in surgical resection of pediatric PCT, with specific focuses on the management of large fibromas. Methods This study included all the children who underwent surgical resection of PCT in our institution between December 2008 and June 2021. The last follow-up was performed between June 1st and August 26th, 2021. Kaplan–Meier method was used to estimate the postoperative survival, freedom from reoperation, event-free survival, and also related risk factors. The tumor volume and volume index (volume divided by body surface area) were measured for cardiac fibromas. Results Of the 39 patients with median operative age of 9.5 [interquartile range (IQR): 1.2–16.5] years, 35 (89.7%) had benign tumors (fibromas for 15, myxomas for 13, and others for 7). The length and volume of fibromas were independent of age and symptoms (Ps > 0.05). The fibroma volume index was negatively correlated with age (P = 0.039), with a mean value of 105 ± 70 ml/m2. Of the 15 patients with fibromas, 5 were asymptomatic, 4 received partial resection, 4 required transmural resection, and 4 presented postoperative left ventricular (LV) dysfunction (ejection fraction <50%). During the median follow-up period of 3.1 years and maximum of 12.5 years, adverse events included 2 early and 1 late death, 4 reoperations, 4 tumor recurrences, and 1 LV dysfunction lasting over one year. The 8-year survival, freedom from reoperation, and event-free survival rates were 90.4, 81.8, and 64.2%, respectively. Malignant tumor (P < 0.001) was associated with more adverse events. Transmural resection (P = 0.022) and larger tumor volume index than LV end-diastolic volume (P = 0.046) were risk factors for LV dysfunction following fibromas resection. Conclusion Pediatric surgery for PCT can be performed with low mortalities and few adverse events. The size of cardiac fibroma in children relatively decreases with the increase of age. Larger tumor volume index than LV end-diastolic volume index and transmural tumor resection predicts postoperative LV dysfunction.
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Affiliation(s)
- Tao Qian
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhongshi Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- National Health Commission Key Laboratory of Birth Defects Research, Prevention, and Treatment, Changsha, China
- *Correspondence: Zhongshi Wu
| | - Yifeng Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Li Xie
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ni Yin
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ting Lu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Can Huang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hui Yang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
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Surgical Treatment of Primary Cardiac Tumors in Children Systematic Review and Meta-analysis. Pediatr Cardiol 2022; 43:251-266. [PMID: 35113182 DOI: 10.1007/s00246-022-02814-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
This systematic review sought to investigate the current evidence regarding surgical management of primary cardiac tumors in children. Twenty-four studies were deemed eligible, reporting on 713 pediatric patients. Cumulative 30-day mortality rate was 5.5% and 7.5% after surgery. It was revealed a statistically lower mortality rate in the group of patients below 1 year of age, justifying a more aggressive surgical approach for primary cardiac tumors, except for rhabdomyoma that can regress spontaneously.
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10
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Janopaul-Naylor J, Kanter KR, Flampouri S, Nguyen V, Olson TA, Eaton BR. Adjuvant chemoradiation for high-grade cardiac leiomyosarcoma in a child: Case report and review of literature. Pediatr Blood Cancer 2021; 68:e29241. [PMID: 34260156 DOI: 10.1002/pbc.29241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/09/2022]
Abstract
A 13-year-old healthy girl presented with dizziness and palpitations, found to have a left atrial mass. An 8-cm tumor was removed en bloc. Pathology confirmed grade 3 leiomyosarcoma with multifocal positive margins. She received adjuvant ifosfamide and doxorubicin, followed by concurrent proton radiotherapy and ifosfamide. Radiotherapy included 66 Gy (RBE) in 33 fractions to the operative bed. Prospectively graded toxicities included Grade 2 esophagitis and Grade 1 anorexia, dermatitis, and fatigue. She completed six cycles of ifosfamide. Two years post operation, she had no evidence of disease, intermittent palpitations with normal cardiac function, and no other cardiopulmonary or esophageal symptoms.
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Affiliation(s)
- James Janopaul-Naylor
- Department of Radiation Oncology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
| | - Kirk R Kanter
- Pediatric Cardiac Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stella Flampouri
- Department of Radiation Oncology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
| | - Vivi Nguyen
- Department of Radiation Oncology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
| | - Thomas A Olson
- Department of Pediatric Hematology and Oncology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Bree R Eaton
- Department of Radiation Oncology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
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11
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Vakrilova L, Marinov R, Hitrova-Nikolova S, Dobrev D, Denev M, Lazarov S. Cardiac Myosarcoma in a Newborn Infant-A Case Report and Literature Review. Front Cardiovasc Med 2021; 8:675202. [PMID: 34336944 PMCID: PMC8316586 DOI: 10.3389/fcvm.2021.675202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Malignant cardiac neoplasms are extremely rare in neonates. Prenatal diagnosis is often not available. Initial symptoms can mimic non-cardiac diseases. We present a pre-mature newborn, birth-weight 2,480 g, 34 gestational weeks, which underwent cardiac surgery due to a cardiac tumor. Case Summary: This was a 3–rd pregnancy after two spontaneous abortions to a mother with thrombophilia, diabetes, hydramnios, and retroplacental hematoma. The baby was admitted to NICU with transitory respiratory failure and inborn infection; hence oxygen-supplementation and antibiotics were initiated. On day 11 a deterioration with tachypnea, high oxygen requirements, significantly increasing C-reactive protein values were noted. Chest radiographs were unremarkable. On day 18 a life-threatening condition with clinical symptoms of shock was identified. Echocardiography showed a large tumor formation in the right atrium, reduced blood flow in the right ventricle and pulmonary artery. On day 19 cardiac surgery was performed: a large tumor with a myxomatous appearance that occupied the cavity of the right atrium and infiltrated the annulus of the tricuspid valve was extirpated. The front wall was restored with a patch. Hemodynamics was temporarily stabilized. On the following day, ventricular fibrillation and asystole occurred. Despite life support efforts, the outcome was lethal. The histological result confirmed leiomyosarcoma of the right atrium and right ventricular hypotrophy. Conclusion: Inborn cardiac sarcomas are extremely rare. The prognosis is poor. Due to fast progression in the third trimester, they can be missed by fetal echocardiography in earlier pregnancy. The postnatal clinical course is aggressive, not specific until invasive infiltration or obstruction by the tumor mass occurred. In our case, the sarcoma mimicked an inborn infection, followed by nosocomial infection and septic shock. Despite low incidence, cardiac tumors should be kept in mind and echocardiography should be conducted if there are unclear symptoms with progressive deterioration during the neonatal period.
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Affiliation(s)
- Liliya Vakrilova
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria.,Department of Neonatology, University Obstetrics and Gynecology Hospital "Maichin Dom", Sofia, Bulgaria
| | - Rumen Marinov
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria.,Department of Pediatric Cardiology, National Cardiac Hospital, Sofia, Bulgaria
| | - Stanislava Hitrova-Nikolova
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria.,Department of Neonatology, University Obstetrics and Gynecology Hospital "Maichin Dom", Sofia, Bulgaria
| | - Dobri Dobrev
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria.,Department of Pediatric Cardiology, National Cardiac Hospital, Sofia, Bulgaria
| | - Maxim Denev
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria.,Department of Pediatric Cardiology, National Cardiac Hospital, Sofia, Bulgaria
| | - Stoyan Lazarov
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria.,Department of Pediatric Cardiology, National Cardiac Hospital, Sofia, Bulgaria
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12
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Szczałuba K, Makuła E, Piórecka-Makuła A, Sicińska J, Rydzanicz M, Gasperowicz P, Płoski R, Werner B. Intracardiac tumor as a rare manifestation of genetic syndromes-presentation of a family with Gorlin syndrome and a literature review. J Appl Genet 2020; 61:559-565. [PMID: 32964316 PMCID: PMC7652740 DOI: 10.1007/s13353-020-00582-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/19/2020] [Accepted: 09/06/2020] [Indexed: 11/29/2022]
Abstract
Intracardiac tumors in children are relatively rare, but their clinical consequences may include severe outflow tract obstruction, embolism, cardiac insufficiency, or rhythm disturbances. In some cases, the tumor may constitute part of a genetic condition and prompt additional investigations, as well as a modification of therapeutic management. Herein, we present a molecularly confirmed familial case of Gorlin syndrome with an early cardiac tumor as a presenting sign. We provide detailed clinical characteristics of the affected individuals and a useful review of syndromic causes of pediatric cardiac tumors in clinical practice.
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Affiliation(s)
- Krzysztof Szczałuba
- Department of Medical Genetics, Medical University of Warsaw, ul Pawinskiego 3c, 02-106, Warsaw, Poland
| | - Ewa Makuła
- Medical University of Warsaw, Warsaw, Poland
| | - Anna Piórecka-Makuła
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Justyna Sicińska
- Clinical Department of Dermatology, Central Clinical Hospital of the MSWiA, Warsaw, Poland
| | - Małgorzata Rydzanicz
- Department of Medical Genetics, Medical University of Warsaw, ul Pawinskiego 3c, 02-106, Warsaw, Poland
| | - Piotr Gasperowicz
- Department of Medical Genetics, Medical University of Warsaw, ul Pawinskiego 3c, 02-106, Warsaw, Poland
| | - Rafał Płoski
- Department of Medical Genetics, Medical University of Warsaw, ul Pawinskiego 3c, 02-106, Warsaw, Poland.
| | - Bożena Werner
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland
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13
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Unusual presentation of an obstructing cardiac myxoma. JTCVS Tech 2020; 3:234-235. [PMID: 34317885 PMCID: PMC8303053 DOI: 10.1016/j.xjtc.2020.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/13/2020] [Accepted: 06/17/2020] [Indexed: 11/22/2022] Open
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14
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Rahouma M, Arisha MJ, Elmously A, El-Sayed Ahmed MM, Spadaccio C, Mehta K, Baudo M, Kamel M, Mansor E, Ruan Y, Morsi M, Shmushkevich S, Eldessouki I, Rahouma M, Mohamed A, Gambardella I, Girardi L, Gaudino M. Cardiac tumors prevalence and mortality: A systematic review and meta-analysis. Int J Surg 2020; 76:178-189. [PMID: 32169566 DOI: 10.1016/j.ijsu.2020.02.039] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Cardiac tumors and their associated outcomes are poorly characterized. This study sought to comprehensively assess the epidemiology and natural history of primary and secondary malignant cardiac tumors (PMCT and SMCT), a well as establish predictors of mortality. METHODS A comprehensive literature review was performed to identify articles reporting on PMCTs and SMCTs. The prevalence of important cardiac tumor (CT) subtypes was evaluated and further stratified based on the continental region. Outcomes of interest included short- and long-term mortality and utilization of heart transplantation (HTX). A random effect model was adopted, and a meta-regression was performed to determine predictors of the prevalence of CTs as well as predictors of operative mortality. RESULTS Of the 1,226 retrieved articles, 74 were included in our study (n = 8,849 patients). The mean follow-up was 2.27 years, mean age was 42.9 years, and 55% of the patients were females. There was a total number of 7,484 benign primary cardiac tumors (PCTs) (5,140 were myxoma), 862 (9.7%) malignant PCTs, and 355 secondary cardiac tumors. The prevalence of PMCTs among PCTs was 10.83% [95%CI = 09.11; 12.83%] with a trend towards being lower in South America compared to other continents (Prevalence = 5.80%). The prevalence of HTX among all patients was 2.45% [1.36; 4.38%]. The pooled short-term mortality was 5.90% [4.70; 7.39%] and the incidence of late mortality in all CTs, benign CT and PMCTs was 2.55% [1.76; 3.72%], 0.79% [0.46; 1.37%] and 14.77% [9.32; 23.40%], respectively. On meta-regression, the annual volume of cardiac tumor cases per center was the only predictor of lower early mortality (Beta = -0.14 ± 0.03, P < 0.0001). CONCLUSIONS PMCTs represent the minority of PCT (~10%) and have a higher prevalence in Europe and North America. Survival is higher in benign pathology and is significantly improved by treatment in specialized high-volume centers. Approximately 2% of patients with CTs undergo heart transplantation.
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Affiliation(s)
- Mohamed Rahouma
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA; Surgical Oncology Department, National Cancer Institute, Cairo University, Egypt.
| | - Mohammed J Arisha
- Internal Medicine Department, West Virginia University Charleston Division, Charleston Area Medical Center, Charleston, WV, USA
| | - Adham Elmously
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | | | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, Glasgow, G814DY, UK; Institute of Cardiovascular and Medical Sciences, Veterinary and Life Sciences, College of Medical, University of Glasgow, Glasgow, G128QQ, UK
| | - Kritika Mehta
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Massimo Baudo
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Mohamed Kamel
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA; Surgical Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Esraa Mansor
- Internal Medicine Department, West Virginia University Charleston Division, Charleston Area Medical Center, Charleston, WV, USA
| | - Yongle Ruan
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Mahmoud Morsi
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Shon Shmushkevich
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Ihab Eldessouki
- Medical Oncology Department, University of Cincinnati Cancer Institute, Cincinnati, OH, USA
| | - Mostafa Rahouma
- Information Technology Department, National Cancer Institute, Cairo University, Egypt
| | - Abdelrahamn Mohamed
- Surgical Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Ivancarmine Gambardella
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Leonard Girardi
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Mario Gaudino
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
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15
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Quinn N, Kalichuran R, Prenderville T, McGuinness J. Point-of-Care Ultrasound echocardiography diagnosis of an atrial myxoma in a child presenting with stroke. Australas J Ultrasound Med 2020; 23:80-83. [PMID: 34760587 PMCID: PMC8411714 DOI: 10.1002/ajum.12201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We describe a case of paediatric stroke secondary to atrial myxoma, diagnosed in the Emergency Department by Point-of-Care echocardiography. A previously fit and healthy teenage male presented to our paediatric emergency department following a collapse with loss of consciousness. He had suffered a stroke, and had facial paralysis and hemiplegia. His cardiac examination revealed a 3/6 ejection systolic murmur. Whilst his CT was being reported, he had a Point-of-Care echocardiogram in the resuscitation room which showed a very large mass arising from the left atrium and occupying >50% of the chamber. A piece of the myxoma had detached and caused the stroke. The patient was rapidly transferred to a cardiac intensive care unit and underwent emergency surgery the same day. His tumour was successfully completely resected, and he has only a mild residual hemiplegia. Cardiac myxoma should be considered in any child who presents with unexplained acute stroke and a cardiac murmur. Point-of-Care Ultrasound echocardiography in the Paediatric Emergency Department can be used to make a life-saving diagnosis, enabling early surgical management and preventing lifelong complications in children.
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Affiliation(s)
- Nuala Quinn
- Department of Paediatric Emergency MedicineChildren's Health Ireland at Temple StreetDublinIreland
- Emergency Research GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Rohan Kalichuran
- Department of Paediatric Emergency MedicineChildren's Health Ireland at Temple StreetDublinIreland
| | | | - Jonathan McGuinness
- Department of Cardiothoracic SurgeryChildren's Health Ireland at CrumlinDublinIreland
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16
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Macias E, Nieman E, Yomogida K, Petrucci O, Javidan C, Baszis K, Anwar S. Rare presentation of an atrial myxoma in an adolescent patient: a case report and literature review. BMC Pediatr 2018; 18:373. [PMID: 30486815 PMCID: PMC6263045 DOI: 10.1186/s12887-018-1313-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 10/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac tumors are uncommon in the pediatric population. When present, cardiac manifestations stem from the tumor causing inflow or outflow obstruction. While common in adults, cardiac myxomas presenting with generalized systemic illness or peripheral emboli especially with no cardiac or neurological symptoms are rare in children. CASE PRESENTATION We report a case of a previously healthy adolescent girl who presented with a 6-month history of constitutional symptoms and a purpuric rash with no cardiac or neurologic symptoms, found to have a cardiac myxoma. CONCLUSIONS A vasculopathic rash in the setting of atrial myxomas has been shown be a precursor to significant morbidity and mortality. Due to the rarity of this entity, the time elapsed from onset of non-cardiac symptoms until diagnosis of a myxoma is usually prolonged with interval development of irreversible neurological sequelae and death reported in the literature. Therefore, we highlight the importance of including cardiac myxomas and paraneoplastic vasculitis early in the differential diagnosis for patients presenting with a purpuric rash and systemic symptoms.
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Affiliation(s)
- Eduardo Macias
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine in St. Louis, One Children's Place, Campus Box 8116-NWT, St. Louis, MO, 63110, USA.
| | - Elizabeth Nieman
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Kentaro Yomogida
- Division of Rheumatology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Orlando Petrucci
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Cylen Javidan
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Kevin Baszis
- Division of Rheumatology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Shafkat Anwar
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine in St. Louis, One Children's Place, Campus Box 8116-NWT, St. Louis, MO, 63110, USA
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17
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Ritter AL, Granquist EJ, Iyer VR, Izumi K. Cardiac Fibroma with Ventricular Tachycardia: An Unusual Clinical Presentation of Nevoid Basal Cell Carcinoma Syndrome. Mol Syndromol 2018; 9:219-223. [PMID: 30140199 DOI: 10.1159/000489056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 12/15/2022] Open
Abstract
Pediatric cardiac tumors are rare and often benign with an incidence of approximately 0.03-0.32% and can be associated with genetic conditions. For example, approximately 3% of individuals with nevoid basal cell carcinoma syndrome (NBCCS), also known as Gorlin syndrome, have a cardiac fibroma. NBCCS is also characterized by lamellar or early calcification of the falx, jaw keratocysts, palmar and/or plantar pits, and a predisposition for basal cell carcinomas. Given the management implications of NBCCS, including appropriate cancer screenings and precautions, prompt identification of affected individuals is critical. We report a case of a 6-year-old female presenting with ventricular tachycardia secondary to cardiac fibroma. After diagnosis of recurrent jaw keratocysts, she was clinically and molecularly diagnosed with NBCCS. Identification of a cardiac fibroma should prompt careful assessment of past medical and family history with consideration of a diagnosis of NBCCS.
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Affiliation(s)
- Alyssa L Ritter
- Division of Human Genetics.,Division of Cardiology, Department of Pediatrics
| | - Eric J Granquist
- Divisions of Department of Oral and Maxillofacial Surgery, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | | | - Kosuke Izumi
- Division of Human Genetics.,Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia
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18
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Yabrodi M, Mastropietro CW, Darragh RK, Parent JJ, Ayres MD, Kean AC, Turrentine M. Management of Complications Caused by a Massive Left Ventricle Tumor in a Neonate. Ann Thorac Surg 2018; 105:e259-e261. [PMID: 29409794 DOI: 10.1016/j.athoracsur.2017.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 11/17/2022]
Abstract
We report the case of a neonate born with a giant fibroma occupying the entirety of her left ventricle. Owing to the extensive resection, her postoperative course was complicated by severely diminished left ventricular function and complete heart block necessitating extracorporeal support. Ultimately, cardiac resynchronization therapy was used, after which the infant's ventricular function gradually improved and she was successfully discharged to home.
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Affiliation(s)
- Mouhammad Yabrodi
- Department of Pediatrics, Division of Critical Care, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Christopher W Mastropietro
- Department of Pediatrics, Division of Critical Care, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Robert K Darragh
- Department of Pediatrics, Division of Cardiology, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - John J Parent
- Department of Pediatrics, Division of Cardiology, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mark D Ayres
- Department of Pediatrics, Division of Cardiology, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Adam C Kean
- Department of Pediatrics, Division of Cardiology, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mark Turrentine
- Department of Surgery, Division of Cardiothoracic Surgery, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana
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Tzani A, Doulamis IP, Mylonas KS, Avgerinos DV, Nasioudis D. Cardiac Tumors in Pediatric Patients: A Systematic Review. World J Pediatr Congenit Heart Surg 2017; 8:624-632. [DOI: 10.1177/2150135117723904] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This systematic review sought to investigate the current evidence regarding surgical management of primary cardiac tumors in children and adolescents. Twenty-eight studies were deemed eligible, reporting on 745 pediatric patients. Rhabdomyoma was the most prevalent histologic type and echocardiography was the most common diagnostic tool. Cumulative 30-day mortality rate was 6.7%. Rhabdomyomas and teratomas had the highest 30-day mortality. The higher percentage of tumor relapse was noted for myxoma and teratoma. Although cardiac tumors are rare, their atypical clinical presentation, potential for recurrence, and the poor prognosis associated with recurrence elucidate the need for reliable diagnostic and therapeutic management.
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Affiliation(s)
- Aspasia Tzani
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | | | - Konstantinos S. Mylonas
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
- Division of Pediatric Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dimitrios V. Avgerinos
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
- Department of Cardiothoracic Surgery, New York Presbyterian Medical Center, Weill Cornell College of Medicine, New York, NY, USA
| | - Dimitrios Nasioudis
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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20
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Ramadani N, Kreshnike KD, Muçaj S, Kabashi S, Hoxhaj A, Jerliu N, Bejiçi R. MRI Verification of a Case of Huge Infantile Rhabdomyoma. Acta Inform Med 2016; 24:146-8. [PMID: 27147810 PMCID: PMC4851540 DOI: 10.5455/aim.2016.24.146-148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/11/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction: Cardiac rhabdomyoma is type of benign myocardial tumor that is the most common fetal cardiac tumor. Cardiac rhabdomyomas are usually detected before birth or during the first year of life. They account for over 60% of all primary cardiac tumors. Case report: A 6 month old child with coughing and obstruction in breathing, was hospitalized in the Pediatric Clinic in UCCK, Pristine. The difficulty of breathing was heard and the pathological noise of the heart was noticed from the pediatrician. In the echo of the heart at the posterior and apico-lateral part of the left ventricle a tumoral mass was presented with the dimensions of 56 × 54 mm that forwarded the contractions of the left ventricle, the mass involved also the left ventricle wall and was not vascularized. The right ventricle was deformed and with the shifting of the SIV on the right the contractility was preserved. Aorta, the left arch and AP were normal with laminar circulation. The pericard was presented free. Radiography of thoracic organs was made; it resulted on cardiomegaly and significant bronchovascular drawing. It was completed with an MRI and it resulted on: Cardiomegaly due to large tumoral mass lesion (60×34 mm) involving lateral wall of left ventricle. It was isointense to the muscle on T1W images, markedly hyperintense on T2W images. There were a few septa or bant like hypointensities within lesion. On postcontrast study it showed avid enhancement. The left ventricle volume was decreased. Mild pericardial effusion was also noted. Surgical intervention was performed and it resulted on the histopathological aspect as a huge infantile rhadbomyoma. Conclusion: In most cases no treatment is required and these lesions regress spontaneously. Patients with left ventricular outflow tract obstruction or refractory arrhythmias respond well to surgical excision. Rhabdomyomas are frequently diagnosed by means of fetal echocardiography during the prenatal period.
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Affiliation(s)
- Naser Ramadani
- Faculty of Medicine, Pristine University, Pristine, Kosovo; National Institute of Public Health of Kosovo, Pristine, Kosovo
| | - Kreshnike Dedushi Kreshnike
- Faculty of Medicine, Pristine University, Pristine, Kosovo; Department of Radiology, Diagnostic Centre, UCCK, Pristine, Kosovo; International Health Center "IHC" Pristine, Kosovo
| | - Sefedin Muçaj
- Faculty of Medicine, Pristine University, Pristine, Kosovo; National Institute of Public Health of Kosovo, Pristine, Kosovo
| | - Serbeze Kabashi
- Faculty of Medicine, Pristine University, Pristine, Kosovo; Department of Radiology, Diagnostic Centre, UCCK, Pristine, Kosovo
| | | | - Naim Jerliu
- Faculty of Medicine, Pristine University, Pristine, Kosovo; National Institute of Public Health of Kosovo, Pristine, Kosovo
| | - Ramush Bejiçi
- Faculty of Medicine, Pristine University, Pristine, Kosovo; Pediatric Clinic, Department of Cardiology UCCK, Pristine, Kosovo
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21
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Takahashi A, Otsuka H, Harada M. Multimodal Cardiovascular Imaging of Cardiac Tumors. ACTA ACUST UNITED AC 2016. [DOI: 10.17996/anc.02.01.61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ayaka Takahashi
- Department of Radiology, Tokushima University Graduate School
| | - Hideki Otsuka
- Department of Medical Imaging / Nuclear Medicine, Tokushima University Graduate School
| | - Masafumi Harada
- Department of Radiology, Tokushima University Graduate School
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22
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Respiratory Failure in an Adolescent with Primary Cardiac Sarcoma. Case Rep Cardiol 2015; 2015:592385. [PMID: 26356285 PMCID: PMC4556824 DOI: 10.1155/2015/592385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 06/29/2015] [Indexed: 11/25/2022] Open
Abstract
We report a case of progressive respiratory failure secondary to primary cardiac sarcoma masquerading as primary lung disease. An 18-year-old female presented to our hospital emergency department with progressive cough, dyspnea, and hemoptysis. She was treated for primary lung infection without improvement and had respiratory failure with endotracheal intubation by the third hospital day. An “intermediate” plasma brain natriuretic protein (BNP) of 216 pg/mL did not raise concerns about a heart failure diagnosis and may have delayed the correct diagnosis. Computed tomography of the chest with intravenous contrast was performed on the fifth hospital day and revealed a cardiac mass. A transthoracic echocardiogram confirmed a large left atrial mass that was obstructing mitral inflow. She was transferred to a tertiary center for emergency cardiac surgery. Primary cardiac tumors are a rare and treatable cause of heart failure in adolescent and young adult patients. Presentation can be confused with primary lung disease and must be suspected early. Plasma BNP cutoff levels used in the adult population should not be extrapolated to adolescents, as levels, both normal and abnormal, are significantly lower in this group of patients.
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