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Khezerlouy Aghdam N, Delkhah M, Danayi S, Sobhi N. Rheumatic heart disease of the mitral valve alongside the papillary fibroelastoma of the aortic valve: A case report. Clin Case Rep 2024; 12:e8845. [PMID: 38689685 PMCID: PMC11060882 DOI: 10.1002/ccr3.8845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/07/2024] [Accepted: 03/27/2024] [Indexed: 05/02/2024] Open
Abstract
Key Clinical Message Besides thromboses, it's crucial to also consider the rare possibility of tumors like papillary fibroelastomas when evaluating worsening cardiopulmonary symptoms in patients with severe rheumatic mitral stenosis and atrial fibrillation. Abstract Cardiac papillary fibroelastoma is a rare and benign endocardial tumor typically found on the aortic valve. The simultaneous occurrence of rheumatic heart disease affecting the mitral valve and papillary fibroelastoma on the aortic valve is infrequent, with limited documented instances. This unique case can enhance our understanding of the clinical presentation, diagnostic approaches, management options, and implications for patient outcomes in these two conditions. We present the case of a 47-year-old woman who was admitted to the hospital due to worsening dyspnea and fatigue, during which time she discovered an aortic valve papillary fibroelastoma. Further investigations revealed two thrombi in her left atrium and left atrial appendage, along with significant rheumatic mitral valve stenosis. The patient underwent thrombectomy, mitral valve replacement, and valve-sparing aortic valve tumor resection. Following surgery, the patient's recovery was unremarkable. This case report emphasizes the need for a comprehensive evaluation in patients with rheumatic mitral stenosis, considering all possible etiologies. While thrombi are typical in mitral stenosis and atrial fibrillation, the rare presence of tumors like papillary fibroelastomas should be recognized, underscoring the importance of further assessment when suspicion arises. Importantly, individuals with asymptomatic cardiac papillary fibroelastomas should undergo surgical treatment to minimize the potential risk of tumoral embolization.
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Affiliation(s)
| | - Mitra Delkhah
- Cardiovascular Research CenterTabriz University of Medical ScienceTabrizIran
| | - Saeid Danayi
- Cardiovascular Research CenterTabriz University of Medical ScienceTabrizIran
| | - Navid Sobhi
- Research Center for Evidence‐Based MedicineIranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Tabriz University of Medical SciencesTabrizIran
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2
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Anne N, Anandaswamy TC, Govindswamy S, Ravichandran G. Anesthetic management of a patient with incidental left atrial myxoma for proximal femur nailing: A case report. Saudi J Anaesth 2024; 18:302-304. [PMID: 38654855 PMCID: PMC11033888 DOI: 10.4103/sja.sja_944_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/10/2023] [Indexed: 04/26/2024] Open
Abstract
Cardiac myxomas are rare tumors with risks of cardiac outflow obstruction and embolic events. Surgical excision of the tumor at the earliest is the definitive treatment. We report the successful anesthetic management of a 65-year-old female patient with incidental left atrial myxoma for right proximal femur nailing. The patient was asymptomatic with no significant cardiac history. Since fracture reduction cannot be deferred for a prolonged period, the case was taken up under general anesthesia with invasive blood pressure monitoring.
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Affiliation(s)
- Namita Anne
- Department of Anaesthesiology, MS Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Tejesh C Anandaswamy
- Department of Anaesthesiology, MS Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Suresh Govindswamy
- Department of Anaesthesiology, MS Ramaiah Medical College, Bengaluru, Karnataka, India
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3
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Chachar TS, Yousif N, Noor HA, Makwana D, Alkhayat MK, Tareif H, Arekat ZR, Amin H. Epidemiology of Cardiac Myxoma in the Kingdom of Bahrain. Cureus 2024; 16:e55704. [PMID: 38586738 PMCID: PMC10998261 DOI: 10.7759/cureus.55704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Cardiac myxomas (CM) are the most prevalent type of primary cardiac tumour. The majority of primary cardiac tumours, including CM, are found to be benign. In the context of this study, the objective was to investigate and analyse the experience of CM over a period of 10 years, specifically in Bahrain. By examining this particular subset of cardiac tumours, valuable insights can be gained regarding their prevalence, clinical presentation, diagnostic methods, treatment approaches, and outcomes in the Bahraini population. METHODS We retrospectively evaluated the medical records of 20 patients who presented with CM at the Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre in the Kingdom of Bahrain from January 2010 to January 2021. All patients had transthoracic echocardiography to establish a preoperative diagnosis. All of the patients underwent an operation using the median sternotomy, and a histopathology examination confirmed the final diagnosis. RESULTS The mean age at the time of presentation was 57 (± 18.1) years, ranging from 17 to 80 years, and 55% (12 patients) were female. Dyspnea (n=8, 40%) and peripheral embolism (n=4, 20%), which include cerebrovascular accidents and acute monocular vision loss, were the most frequently observed symptoms. The largest diameter of the myxoma was 5.1 cm (±1.7). The left atrium was the predominant location for myxoma formation (n=16, 80%), with the majority of the myxomas attached to the atrial septum. CONCLUSION CM poses a significant risk of cardiac and systemic complications. Early detection and timely gross-complete resection result in excellent early and long-term outcomes.
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Affiliation(s)
- Tarique S Chachar
- Cardiology, Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre, Awali, BHR
| | - Nooraldaem Yousif
- Interventional Cardiology, Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre, Awali, BHR
| | - Husam A Noor
- Interventional Cardiology, Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre, Awali, BHR
| | - Dayaram Makwana
- Cardiology, Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre, Awali, BHR
| | - Mohamed K Alkhayat
- Cardiothoracic Surgery, Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre, Awali, BHR
| | - Habib Tareif
- Cardiothoracic Surgery, Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre, Awali, BHR
| | - Zaid R Arekat
- Cardiothoracic Surgery, Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre, Awali, BHR
| | - Haitham Amin
- Interventional Cardiology, Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre, Awali, BHR
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4
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Diamond MS. Immune Checkpoint Inhibitors in Cardiac Sarcoma: Reason to Take Heart? JACC CardioOncol 2024; 6:80-82. [PMID: 38510298 PMCID: PMC10950427 DOI: 10.1016/j.jaccao.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Affiliation(s)
- Mark S. Diamond
- Division of Hematology Oncology, University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania, USA
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5
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Swinn T, El-Medany A, Laisha G. The mass that should not be there: Multi-modality imaging shapes diagnostic reasoning. Echocardiography 2024; 41:e15787. [PMID: 38400623 DOI: 10.1111/echo.15787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
A rare case of pulmonary artery fibroelastoma that demonstrates the importance of multimodality imaging and serial scans in reducing diagnostic uncertainty.
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Nassar AH, El-Am E, Denu R, Abou Alaiwi S, El Zarif T, Macaron W, Abdel-Wahab N, Desai A, Smith C, Parikh K, Abbasi M, Bou Farhat E, Williams JM, Collins JD, Al-Hader A, McKay RR, Malvar C, Sabra M, Zhong C, El Alam R, Chehab O, Lima J, Phan M, Dalla Pria HF, Trevino A, Neilan TG, Kwan JM, Ravi V, Deshpande H, Demetri G, Choueiri TK, Naqash AR. Clinical Outcomes Among Immunotherapy-Treated Patients With Primary Cardiac Soft Tissue Sarcomas: A Multicenter Retrospective Study. JACC CardioOncol 2024; 6:71-79. [PMID: 38510282 PMCID: PMC10950431 DOI: 10.1016/j.jaccao.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 03/22/2024] Open
Abstract
Background Primary cardiac soft tissue sarcomas (CSTS) affect young adults, with dismal outcomes. Objectives The aim of this study was to investigate the clinical outcomes of patients with CSTS receiving immune checkpoint inhibitors (ICIs). Methods A retrospective, multi-institutional cohort study was conducted among patients with CSTS between 2015 and 2022. The patients were treated with ICI-based regimens. The Kaplan-Meier method was used to estimate overall survival (OS) and progression-free survival (PFS). Objective response rates were determined according to Response Evaluation Criteria in Solid Tumors version 1.1. Treatment-related adverse events were graded per the Common Terminology Criteria for Adverse Events version 5.0. Results Among 24 patients with CSTS, 17 (70.8%) were White, and 13 (54.2%) were male. Eight patients (33.3%) had angiosarcoma. At the time of ICI treatment, 18 patients (75.0%) had metastatic CSTS, and 4 (16.7%) had locally advanced disease. ICIs were administered as the first-line therapy in 6 patients (25.0%) and as the second-line therapy or beyond in 18 patients (75.0%). For the 18 patients with available response data, objective response rate was 11.1% (n = 2 of 18). The median PFS and median OS in advanced and metastatic CSTS (n = 22) were 5.7 months (95% CI: 2.8-13.3 months) and 14.9 months (95% CI: 5.7-23.7 months), respectively. The median PFS and OS were significantly shorter in patients with cardiac angiosarcomas than in those with nonangiosarcoma CSTS: median PFS was 1.7 vs 11 months, respectively (P < 0.0001), and median OS was 3.0 vs 24.0 months, respectively (P = 0.008). Any grade treatment-related adverse events occurred exclusively in the 15 patients with nonangiosarcoma CSTS (n = 7 [46.7%]), of which 6 (40.0%) were grade ≥3. Conclusions Although ICIs demonstrate modest activity in CSTS, durable benefit was observed in a subset of patients with nonangiosarcoma, albeit with higher toxicity.
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Affiliation(s)
- Amin H. Nassar
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Edward El-Am
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan Denu
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Talal El Zarif
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Walid Macaron
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Noha Abdel-Wahab
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aakash Desai
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Caleb Smith
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kaushal Parikh
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Muhannad Abbasi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Ahmad Al-Hader
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rana R. McKay
- Moores Cancer Center, University of California-San Diego, La Jolla, California, USA
| | - Carmel Malvar
- Moores Cancer Center, University of California-San Diego, La Jolla, California, USA
| | - Mohamad Sabra
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Caiwei Zhong
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Omar Chehab
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore Maryland, USA
| | - Joao Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore Maryland, USA
| | - Minh Phan
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | | | - Alexandra Trevino
- Department of Internal Medicine, Northwestern University, Chicago, Illinois, USA
| | - Tomas G. Neilan
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Vinod Ravi
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hari Deshpande
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - George Demetri
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Abdul Rafeh Naqash
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
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Tang C, Gao X, Chen T, Shao J, Zhu T, Zheng X, Ren C. Case Report: Acute cerebral infarction caused by left atrial and right ventricular myxoma received emergency operation. Front Cardiovasc Med 2024; 10:1316063. [PMID: 38283175 PMCID: PMC10811181 DOI: 10.3389/fcvm.2023.1316063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Cardiac myxoma is a rare etiology of ischemic stroke, especially in young people. We report a case of multiple myxomas in left atrium and right ventricle inducing acute cerebral infarction. No significant abnormalities were detected in the patient's preoperative laboratory examination. Following emergency surgery, the patient's prognosis was satisfactory, providing valuable empirical insight for the surgical management of acute cerebral infarction in individuals diagnosed with cardiac myxoma. Our objective is to heighten awareness regarding the evaluation and treatment of patients with acute cerebral infarction subsequent to early diagnosis of cardiac myxoma.
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Affiliation(s)
- Chengbin Tang
- Department of Cardiovascular Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- The Yangzhou Clinical Medical College of Xuzhou Medical University, Xuzhou, China
| | - Xianglong Gao
- Department of Cardiovascular Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- The Yangzhou Clinical Medical College of Xuzhou Medical University, Xuzhou, China
| | - Tao Chen
- Department of Cardiovascular Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- The Yangzhou Clinical Medical College of Xuzhou Medical University, Xuzhou, China
| | - Jun Shao
- Department of Cardiovascular Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- The Yangzhou Clinical Medical College of Xuzhou Medical University, Xuzhou, China
| | - Tao Zhu
- Department of Cardiovascular Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- The Yangzhou Clinical Medical College of Xuzhou Medical University, Xuzhou, China
| | - Xucai Zheng
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Chuanli Ren
- Department of Laboratory Medicine, Clinical College of Yangzhou University, Yangzhou, Jiangsu, China
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8
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Jiang H, Liu H, Zhao L, Yang L, Zhao Y. A rare presentation of primary cardiac diffuse large B‑cell lymphoma: A case report. Oncol Lett 2024; 27:40. [PMID: 38108070 PMCID: PMC10722522 DOI: 10.3892/ol.2023.14174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Primary cardiac lymphomas display a low frequency, sudden onset, swift progression of illness and elevated mortality rates. The current study presents a unique instance of primary cardiac diffuse large B-cell lymphoma and examines its clinical manifestations, pathological characteristics and differential diagnosis. A 64-year-old male patient sought medical attention due to cardiac debility and exertional dyspnea persisting for >10 days. Chest enhanced computed tomography revealed a moderately enhancing irregular mass in the ventricular area, exhibiting limited demarcation from the pericardium and left atrium, accompanied by irregular thickening of the interventricular septum. The postoperative specimen showed the presence of yellow fish-like tumor tissue. Immunohistochemical analysis revealed the presence of lymphocytes positive for CD20, BCL-2, BCL-6, c-Myc-binding protein, mutated melanoma-associated antigen 1 and CD79a, along with a high Ki-67 proliferation index of 80%. Conversely, CD10, CD30, CD3, pan cytokeratin, cyclin D1, desmin and vimentin marker results were found to be negative. Additionally, in situ hybridization demonstrated a lack of Epstein-Barr virus-encoded small RNA expression. The present case report emphasizes the significance of conducting a thorough analysis of the clinical manifestations of diffuse large B-cell lymphoma to assist clinicians in establishing a diagnosis and determining an effective treatment approach, thereby enhancing the patient's prognosis.
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Affiliation(s)
- Hongyan Jiang
- Department of Pathology, Suining Central Hospital, Suining, Sichuan 629000, P.R. China
| | - Haijun Liu
- Department of Ultrasound, Suining Central Hospital, Suining, Sichuan 629000, P.R. China
| | - Linwei Zhao
- Department of Radiology and Imaging, Suining Central Hospital, Suining, Sichuan 629000, P.R. China
| | - Ling Yang
- Department of Pathology, Suining Central Hospital, Suining, Sichuan 629000, P.R. China
| | - Yunfei Zhao
- Department of Pathology, Suining Central Hospital, Suining, Sichuan 629000, P.R. China
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9
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Aston A, Harowicz MR, Grizzard JD, Bottinor W. Massive Mysteries. Am J Cardiol 2023; 204:178-182. [PMID: 37544141 PMCID: PMC10528874 DOI: 10.1016/j.amjcard.2023.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023]
Abstract
Papillary fibroelastomas are benign masses often originating from the endocardium of the aortic and mitral valves. Rarely, these neoplasms are found in areas of the heart embryonically distinct from the aortic and mitral valves. Diagnosis of a papillary fibroelastoma relies on multimodal imaging as well as histologic assessment. A case series of papillary fibroelastomas in unusual locations is presented, highlighting the role of multimodal imaging techniques in identifying these intra-cardiac masses. Differential diagnoses, imaging characteristics, histopathology, and preferred management strategies for cardiac masses are reviewed. The unique imaging qualities of cardiac masses are discussed.
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Affiliation(s)
- Adam Aston
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Michael R Harowicz
- Department of Radiology, Duke University Hospital, Durham, North Carolina
| | - John D Grizzard
- Department of Radiology, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Wendy Bottinor
- Department of Cardiology, Virginia Commonwealth University Health System, Richmond, Virginia.
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Appiah D, Goodart CR, Kothari GK, Ebong IA, Nwabuo CC. Reduced Risk of All-Cause, Cancer-, and Cardiovascular Disease-Related Mortality among Patients with Primary Malignant Cardiac Tumors Receiving Chemotherapy in the United States. Curr Oncol 2023; 30:8488-8500. [PMID: 37754533 PMCID: PMC10529023 DOI: 10.3390/curroncol30090618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
Primary malignant cardiac tumors (PMCTs) are rare but lethal neoplasms. There are limited evidence-based treatment guidelines for PMCTs. We evaluated the relation of chemotherapy with mortality outcomes in patients with PMCTs in the United States. Data were from patients aged ≥ 20 years from the Surveillance, Epidemiology, and End Results program who were diagnosed with PMCTs from 2000 to 2020. Cox regression, competing risk, and propensity score analyses were performed to estimate hazard ratios (HR) and confidence intervals (CI). About 53% of the 563 patients with PMCTs received chemotherapy as the first course of treatment. During a mean follow-up of 24.7 months (median: 10), 458 deaths occurred with 81.7% and 9.4% due to cancer and cardiovascular disease (CVD), respectively. In models adjusted for sociodemographic and clinico-pathophysiological factors including histology, receipt of chemotherapy was associated with low risk for all-cause (HR: 0.56, 95%CI: 0.45-0.69), cancer (HR: 0.63, 95%CI: 0.50-0.80) and CVD mortality (HR: 0.27, 95%CI: 0.12-0.58). Patients who had both chemotherapy and surgery had the lowest risk for all-cause and cancer mortality. This study suggests that the subpopulations of patients with PMCTs who receive chemotherapy may have better prognosis than those who do not receive this therapy regardless of histology.
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Affiliation(s)
- Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Carina R. Goodart
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Grishma K. Kothari
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Imo A. Ebong
- Division of Cardiovascular Medicine, University of California, Davis, Sacramento, CA 95616, USA
| | - Chike C. Nwabuo
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
- Ronin Institute, Montclair, NJ 07043, USA
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Rahouma M, Baudo M, El-Sayed Ahmed MM. Editorial: Editor's challenge: Mohamed Rahouma - how can we optimize the management and treatment of cardiac tumors and cardiac complications of cancer? Front Oncol 2023; 13:1271452. [PMID: 37711204 PMCID: PMC10499383 DOI: 10.3389/fonc.2023.1271452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/22/2023] [Indexed: 09/16/2023] Open
Affiliation(s)
- Mohamed Rahouma
- Cardiothoracic Surgery Departments, Weill Cornell Medicine, New York, NY, United States
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Massimo Baudo
- Cardiothoracic Surgery Departments, Weill Cornell Medicine, New York, NY, United States
- Cardiac Surgery Department, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Magdy M. El-Sayed Ahmed
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, FL, United States
- Department of Surgery, Zagazig University Faculty of Medicine, Zagazig, Egypt
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12
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Zhang S, Wang J, Song F, Yang F, Li F, Liu S, Ma J, Zhang H, Ma X. Case report: Left atrial myxoma with morphology of cavernous hemangioma supplied by the right coronary artery. Front Cardiovasc Med 2023; 10:1207339. [PMID: 37593147 PMCID: PMC10427500 DOI: 10.3389/fcvm.2023.1207339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Here, we report an unusual case of left atrial myxoma presented with morphology of cavernous hemangioma supplied by the right coronary artery. Surgical resection of the left atrium myxoma was performed, and the patient experienced an uneventful recovery during hospitalization.
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Affiliation(s)
- Shouji Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Junlin Wang
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Fahang Song
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Fan Yang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Fang Li
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Shangxin Liu
- Imaging Department, Pingyin Chinese Medicine Hospital, Jinan, China
| | - Jiwei Ma
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Haizhou Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xiaochun Ma
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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Collado-Rivera CJ, Vojniku K, Sharma M, Fernandez HA, Kaell AT. Cardiac Papillary Fibroelastoma: Atypical Presentation Mimicking Infective Endocarditis With False Positive Commensal Blood Cultures. Cureus 2023; 15:e42660. [PMID: 37644918 PMCID: PMC10462397 DOI: 10.7759/cureus.42660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/31/2023] Open
Abstract
Cardiac papillary fibroelastomas (CPFs) are rare benign cardiac neoplasms that carry a high risk of embolization if not diagnosed and managed in a timely manner. As most patients are asymptomatic, CPF may be incidentally detected on transthoracic echocardiography (TTE) when performed for other indications. Management of incidental CPF in asymptomatic patients is debatable. We report an unusual case of an incidental CPF in an asymptomatic patient admitted to the hospital for presumed infective endocarditis (IE). Two weeks following laser resection of laryngeal cancer (LC), a new pansystolic murmur was audible during a routine cardiology visit. Outpatient TTE revealed a "vegetation-like" lesion on the mitral valve (MV). Blood cultures (BC) with Gram-positive cocci in clusters (GPC) were reported within 24 hours. This prompted hospital admission for empiric antibiotics. A transesophageal echocardiogram (TEE) confirmed the lesion to be an echogenic mass attached to the MV consistent with CPF. Repeat BC, prior to empiric antibiotic initiation, were all negative. In the absence of all other signs and symptoms of IE, it was determined that the initial BC was false positive and IE was ruled out. Surgical resection was performed due to the potential risk of embolization. The pathology confirmed the diagnosis of CPF with negative tissue cultures.
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Affiliation(s)
| | - Krisela Vojniku
- Internal Medicine, Mather Hospital Northwell Health, Port Jefferson, USA
| | - Mohit Sharma
- Cardiology, Mather Hospital Northwell Health, Port Jefferson, USA
| | - Harold A Fernandez
- Cardiothoracic Surgery, South Shore University Hospital Northwell Health, Bay Shore, USA
| | - Alan T Kaell
- Internal Medicine, Mather Hospital Northwell Health, Port Jefferson, USA
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14
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Samia AM, Boyer PJ. Atrial Myxoma Presenting With Hemorrhage and Multifocal Infarcts in the Brain of a 59-Year-Old Man: An Uncommon Outcome for the Most Common Primary Heart Neoplasm. Cureus 2023; 15:e41323. [PMID: 37539427 PMCID: PMC10394492 DOI: 10.7759/cureus.41323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 08/05/2023] Open
Abstract
Atrial myxomas are the most common primary neoplasm of the heart. Due to their mass effect, they may lead to dysfunction of the heart or mitral valve. Rarely, neoplastic fragments may embolize or a thrombus secondary to stasis may form, which can infarct downstream structures (e.g., the brain). We report the case of a 59-year-old man presenting with headaches, visual changes, and word-finding difficulty secondary to multifocal brain lesions that were identified on computed tomography and magnetic resonance imaging. After an extensive workup, the etiology of the patient's neurological symptoms was determined to be embolization from a large atrial myxoma (2.3x3.5 cm). Histologic and immunohistochemical examination of the atrial myxoma and largest brain lesion yielded similarities, including the presence of spindle-shaped and stellate cells, myxoid regions, Alcian blue pH 2.5 positivity, calretinin positivity, cluster of differentiation 34 (CD34) positivity, and cluster of differentiation 68 (CD68) negativity. This case was remarkable due to the patient's late presentation, the large size of the atrial myxoma, the presence of abundant cerebral hemisphere and cerebellar lesions, and the histologic comparison of the heart and brain lesions. Atrial myxomas have been reported from childhood to late adulthood and when symptoms typically present clinically due to the mass effect. However, neurologic manifestations from embolization or thrombus formation can occur, as in the present case. Therefore, considering the presence of atrial myxomas is important in patients with neurologic manifestations and heart murmurs.
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Affiliation(s)
| | - Philip J Boyer
- Pathology and Laboratory Medicine, Vidant Medical Center/East Carolina University, Greenville, USA
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15
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Yang Z, Niu Y, Ma H, Gong W, Yu L, Liu L, Zheng M. Contrast-enhanced echocardiographic diagnosis of benign and malignant cardiac tumors and its correlation with pathology. Front Cardiovasc Med 2023; 10:1182334. [PMID: 37363101 PMCID: PMC10285073 DOI: 10.3389/fcvm.2023.1182334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Background This study aimed to explore the diagnostic value of contrast-enhanced echocardiography (CEE) in benign and malignant cardiac tumors and detect the correlation of CEE parameters and immunohistochemistry (IHC) markers. Methods The data of 44 patients with cardiac tumors confirmed by pathology were reviewed. Lesions were examined before surgery using transthoracic echocardiography (TTE) and CEE with time-intensity curve analysis. The expression of CD31, VEGF and Ki67 was measured by IHC staining. Microvessel density (MVD) was quantified via IHC for CD31. The clinical variables, TTE, CEE and IHC parameters were compared between benign and malignant cardiac tumors. Receiver operating characteristic curve were used to analyze the value of factors in predicting malignant cardiac tumors. The correlation between CEE and IHC parameters was analyzed. Results Among 44 cardiac tumors, 34 were benign and 10 were malignant. There were significant differences in the TTE parameters (pericardial effusion, tumor boundary, diameter, basal width), CEE parameters (tumor peak intensity (TPI), peak intensity ratio of tumor to myocardium (TPI/MPI), area under time-intensity curve (AUTIC)) and IHC parameters (Ki67, MVD, CD31, VEGF) between the benign and malignant tumor groups (all P < 0.05). Receiver operating characteristic curve analysis showed that the CEE and IHC parameters had diagnostic value in malignant cardiac tumors. There was a correlation between TPI/MPI and Ki67 (r = 0.62), AUTIC and Ki67 (r = 0.50), and AUTIC and CD31 (r = 0.56). Conclusion TTE and CEE parameters were different between benign and malignant cardiac tumors. CEE is helpful to differentiate the properties of cardiac tumors. There is a correlation between CEE parameters and IHC markers. AUTIC and TPI/MPI can reflect the proliferation and invasion of tumors.
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Affiliation(s)
- Zihao Yang
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yicui Niu
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Hui Ma
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Wenqing Gong
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Lu Yu
- Department of Pathology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Liwen Liu
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Minjuan Zheng
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
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16
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Gaisendrees C, Luehr M, Siemanowski J, Siebolts U, Kuhn-Régnier F, Wahlers T. Aortic Paraganglioma Masking as Intramural Hematoma: When You Hear Hoofbeats Think Zebras, Not Horses. JACC Case Rep 2023; 15:101852. [PMID: 37283833 PMCID: PMC10240262 DOI: 10.1016/j.jaccas.2023.101852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 06/08/2023]
Abstract
A 52-year-old woman presented dyspnea and angina. The computed tomography scan indicated an intramural hematoma, and the patient underwent surgery, during which a structure was excised that was identified as aortic paraganglioma. This case report underlines the importance of a multiprofessional interdisciplinary team to diagnose and treat cardiac masses. (Level of Difficulty: Advanced.).
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Affiliation(s)
| | - Maximilian Luehr
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Jana Siemanowski
- Department of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Udo Siebolts
- Department of Pathology, University Hospital of Cologne, Cologne, Germany
| | | | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
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17
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Șerban A, Dădârlat-Pop A, Tomoaia R, Trifan C, Molnar A, Manole S, Achim A, Suceveanu M. The Role of Multimodality Imaging in the Diagnosis and Follow-Up of Malignant Primary Cardiac Tumors: Myxofibrosarcoma-A Case Report and Literature Review. Diagnostics (Basel) 2023; 13:diagnostics13101811. [PMID: 37238295 DOI: 10.3390/diagnostics13101811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Cardiac tumors are a very rare but heterogenous group of diseases that may reveal themselves through a variety of nonspecific cardiac symptoms that may pose a challenge to the diagnostic process. Myxofibrosarcoma is a particularly rare type of cardiac tumor that carries a poor prognosis, thus making accurate and timely diagnosis essential. A 61-year-old woman presented with fatigue and shortness of breath during mild exercise, symptoms that have progressively worsened during the previous year. Multimodality imaging consisting of transthoracic and transesophageal echocardiography (TTE and TEE), cardiac magnetic resonance (CMR), cardiac computer tomography (CCT), and fluorodeoxyglucose positron emission computer tomography (18F-FDG PET-CT) was used for the diagnosis and postoperative follow-up of a myxofibrosarcoma.
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Affiliation(s)
- Adela Șerban
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
- 5th Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Alexandra Dădârlat-Pop
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
- 5th Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Raluca Tomoaia
- 5th Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- Clinical Rehabilitation Hospital, 46-50 Viilor Street, 400347 Cluj-Napoca, Romania
| | - Cătălin Trifan
- Cardiovascular Surgery Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Adrian Molnar
- Cardiovascular Surgery Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Simona Manole
- Radiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Alexandru Achim
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Mihai Suceveanu
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
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18
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Rahouma M, Baudo M, Khairallah S, Dabsha A, Tafuni A, El-Sayed Ahmed MM, Lau C, Iannacone E, Naka Y, Girardi L, Gaudino M, Lorusso R, Mick SL. Primary Cardiac Schwannoma: A Meta-Analysis of Individual Case Reports. J Clin Med 2023; 12:jcm12103356. [PMID: 37240461 DOI: 10.3390/jcm12103356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Primary cardiac schwannoma (PCS) is a neurogenic tumor that arises from Schwann cells. Malignant schwannoma (MSh) is an aggressive cancer comprising 2% of all sarcomas. Information on the proper management of these tumors is limited. Four databases were searched for case reports/series of PCS. The primary outcome was overall survival (OS). Secondary outcomes included therapeutic strategies and the corresponding outcomes. Among 439 potentially eligible studies, 53 met the inclusion criteria. The patients included had 43.72 ± 17.76 years and 28.3% were males. Over 50% of patients had MSh, with 9.4% also demonstrating metastases. Schwannoma commonly occurs in the atria (66.0%). Left-sided PCS were more common than right-sided ones. Surgery was performed in almost 90% of the cases; chemotherapy and radiotherapy were used in 16.9% and 15.1% of cases, respectively. Compared to benign cases, MSh occurs at a younger age and is commonly located on the left side. OS of the entire cohort at 1 and 3 years were 60.7%, and 54.0%, respectively. Females and males OS were similar up to 2 years follow-up. Surgery was associated with higher OS (p < 0.01). Surgery is the primary treatment option for both benign and malignant cases and was the only factor associated with a relative improvement in survival.
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Affiliation(s)
- Mohamed Rahouma
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - Massimo Baudo
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
- Cardiac Surgery Department, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Sherif Khairallah
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - Anas Dabsha
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - Alessandro Tafuni
- Unit of Pathology, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Magdy M El-Sayed Ahmed
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, FL 32224, USA
- Department of Surgery, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Christopher Lau
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
| | - Erin Iannacone
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
| | - Yoshifumi Naka
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
| | - Leonard Girardi
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
| | - Mario Gaudino
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht University, 6202 AZ Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, 6229 ER Maastricht, The Netherlands
| | - Stephanie L Mick
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
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19
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Clark M, Griborio-Guzman AG, Burute NP, Lubbers S, Anthes ML, Sadreddini M, Aseyev OI. When tissue is not the only issue: Poorly differentiated lung squamous-cell carcinoma with adrenal, costochondral, and cardiac metastases - case report. Front Oncol 2023; 13:1117024. [PMID: 36761964 PMCID: PMC9902933 DOI: 10.3389/fonc.2023.1117024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/09/2023] [Indexed: 01/25/2023] Open
Abstract
Nonmelanoma skin cancer is the most common cancer in the world, and lung cancer is the leading cause of death from cancer. Histologically, squamous cell carcinoma (SCC) is the second most prevalent type of both skin and lung cancers. We report the case of a 38-year-old female with metastatic, poorly differentiated lung SCC detected on chest X-ray after she presented to the hospital with cough and dyspnea. She had had a 7.5 cm moderately differentiated well-circumscribed posterior scalp SCC completely excised eight years earlier. CT scan showed a large right lung mass, nodular filling defect in the left atrium (LA), and metastases to the adrenal glands and the first rib. Her pulmonary tumor extends to the LA via the right superior pulmonary vein, which is rarely reported in the literature. Ultrasound-guided biopsy of the rib mass showed poorly differentiated SCC. The patient received urgent radiotherapy, given superior vena cava and mainstem bronchus compression. Head CT showed no brain metastasis. A biopsy of the left adrenal initially reported an undifferentiated pleomorphic sarcoma; however, a second pathologist reported it as a poorly differentiated carcinoma of lung origin. At least three pathologists verified the specimen, and it had a PD-L1 test with a 1-49% score. An initial echocardiogram confirmed the LA mass. The patient received a Paclitaxel-Carboplatin-Pembrolizumab regimen as the first-line treatment for metastatic SCC. A repeat echocardiogram after cycle 1 showed a decrease in the size of the tumor in the LA. Almost five months after her initial visit, this young woman's symptoms and performance status have improved post-palliative radiotherapy and chemo-immunotherapy. Follow-up CT showed smaller lung, nodal, adrenal, and costochondral masses, and evidence of necrosis. This case is clinically relevant because it represents a common problem presenting uncommonly. Moreover, it highlights that ultrasound-guided interventions and medical imaging are essential in directing metastatic cancer diagnosis, treatment, and follow-up, especially when pathology cannot confirm but only presume a specific diagnosis.
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Affiliation(s)
- Megan Clark
- Northern Ontario School of Medicine University, Thunder Bay, ON, Canada
| | - Andres G. Griborio-Guzman
- Northern Ontario School of Medicine University, Thunder Bay, ON, Canada,Division of Cardiology, Department of Internal Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | - Nishigandha P. Burute
- Northern Ontario School of Medicine University, Thunder Bay, ON, Canada,Department of Diagnostic Imaging, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | - Sonja Lubbers
- Northern Ontario School of Medicine University, Thunder Bay, ON, Canada,Department of Internal Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | - Margaret L. Anthes
- Northern Ontario School of Medicine University, Thunder Bay, ON, Canada,Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada,Regional Cancer Care Northwest, Thunder Bay, ON, Canada
| | - Masoud Sadreddini
- Northern Ontario School of Medicine University, Thunder Bay, ON, Canada,Division of Cardiology, Department of Internal Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | - Olexiy I. Aseyev
- Northern Ontario School of Medicine University, Thunder Bay, ON, Canada,Regional Cancer Care Northwest, Thunder Bay, ON, Canada,Department of Medical Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada,*Correspondence: Olexiy I. Aseyev,
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20
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Hurtado-Sierra D, Ramos Garzón JX, Rojas LZ, Fernández-Gómez O, Manrique-Rincón F. Case report: Accelerated regression of giant cardiac rhabdomyomas in neonates with low dose everolimus. Front Pediatr 2023; 11:1109646. [PMID: 36873633 PMCID: PMC9975344 DOI: 10.3389/fped.2023.1109646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/23/2023] [Indexed: 02/17/2023] Open
Abstract
Cardiac rhabdomyoma (CRHM) is the principal cardiac tumor in children and is most often associated with tuberous sclerosis complex (TSC). Mutations in the TSC1 and TSC2 genes cause the overactivation of the mammalian Target of Rapamycin (mTOR). This protein family is responsible for abnormal cell proliferation leading to the formation of CRHMs and hamartomas in other organs. Despite the tendency for spontaneous regression, some CRHMs can cause heart failure and intractable arrhythmias, requiring surgical resection. In recent years, the use of everolimus and sirolimus (mTOR inhibitors) in the treatment of CRHMs has been reported. We report two cases of neonates with giant rhabdomyomas, with hemodynamic repercussions treated with low-dose everolimus (4.5 mg/m2/week). In both cases, we obtained an approximate decrease of 50% in the total area of the mass after three weeks of treatment. Despite rebound growth after stopping the drug, we were able to evidence that the use of low doses of everolimus immediately after birth is effective and safe in the treatment of giant CRHMs, avoiding surgical resection of the tumor and associated morbidity and mortality.
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Affiliation(s)
- Daniel Hurtado-Sierra
- Pediatric Cardiology Unit, Instituto del Corazón de Bucaramanga, Bucaramanga, Colombia
| | | | - Lyda Z Rojas
- Research Center, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
| | - Oscar Fernández-Gómez
- Pediatric Cardiology Unit, Instituto del Corazón de Bucaramanga, Bucaramanga, Colombia
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21
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Chojdak-Łukasiewicz J, Budrewicz S, Waliszewska-Prosół M. Cerebral Aneurysms Caused by Atrial Myxoma-A Systematic Review of the Literature. J Pers Med 2022; 13:8. [PMID: 36675669 PMCID: PMC9861364 DOI: 10.3390/jpm13010008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/11/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background: The association between cerebral aneurysms and left atrial myxoma is known but rare. We described its pathogenesis, clinical presentation, diagnostic findings and treatment using a systemic review of the literature. Methods: MEDLINE via PubMed was searched for articles published until August 2022 using the keywords "atrial myxoma", "cardiac myxoma" and "cerebral aneurysm". Results: In this review, 55 patients with multiple myxomas aneurysms were analyzed, and 65% were women. The average age when aneurysms were diagnosed was 42.5 ± 15.81; most patients were less than 60 years old (86%). Aneurysms could be found before the diagnosis, at the same time as cardiac myxoma, or even 25 years after resection of the atrial mass. In our review, the mean time to diagnoses was 4.5 years. Our review estimates that the most common symptoms were vascular incidents (25%) and seizures (14.3%). In 15 cases, variable headaches were reported. Regarding management strategies, 57% cases were managed conservatively as the primary choice. Conclusions: Although cerebral aneurysms caused by atrial myxoma are rare, the long-term consequences can be serious and patients should be monitored.
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22
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Pino PG, Moreo A, Lestuzzi C. Differential diagnosis of cardiac tumors: General consideration and echocardiographic approach. J Clin Ultrasound 2022; 50:1177-1193. [PMID: 36218203 PMCID: PMC9828386 DOI: 10.1002/jcu.23309] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
Cardiac tumors may be primary (either benign or malignant) or secondary (malignant) and are first detected by echocardiography in most cases. The cardiologist often challenges their identification, the differential diagnosis and the best therapeutic approach. Malignant tumors have usually a poor prognosis, which may be significantly improved by appropriate and timely therapies. The echocardiographic aspects of benign and malignant cardiac tumors described in this article, along with a clinical evaluation may orient the differential diagnosis and aid in choosing the further steps useful to define the nature of the mass.
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Affiliation(s)
- Paolo G. Pino
- Former Chief of Non Invasive Cardiovascular Diagnostics DepartmentOspedale San CamilloRomeItaly
| | - Antonella Moreo
- Cardiology IV, 'A.De Gasperis'DepartmentNiguarda Ca' Granda HospitalMilanItaly
| | - Chiara Lestuzzi
- Cardio‐oncological Rehabilitation Service, Azienda Sanitaria Friuli Occidentale (ASFO)c/o National Cancer Institute (CRO), IRCCSAvianoItaly
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23
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Gaisendrees C, Gerfer S, Schröder C, Schlachtenberger G, Walter S, Ivanov B, Eghbalzadeh K, Lühr M, Djordjevic I, Rahmanian P, Mader N, Kuhn-Régnier F, Wahlers T. Benign and malignant cardiac masses: long-term outcomes after surgical resection. Expert Rev Anticancer Ther 2022; 22:1153-1158. [PMID: 35997214 DOI: 10.1080/14737140.2022.2116006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cardiac tumors represent a rare and heterogenous pathologic entity, with a cumulative incidence of up to 0.02%. This study aimed to investigate one of the largest patient cohorts published for clinical presentation and long-term outcomes after surgical resection. RESEARCH DESIGN Between 2009 and 2021, 183 consecutive patients underwent surgery for tumor excision in our center. Preoperative baseline characteristics, intraoperative data, and long-term survival were analyzed. The diagnosis was confirmed postoperatively by histology and Immunohistochemical investigations. Kaplan-Meier curves assessed survival, and the Cox, proportional hazards model, was used to identify prognostic factors for overall survival. RESULTS This series included 183 consecutive patients; most (n=169, 92.3%) were diagnosed with benign cardiac masses. The mean age of patients was 60 ± 16 years, and 48% (n=88) were females. The largest group of tumors is represented by myxoma (n = 98; 54%). The most common malignant tumor was sarcomas (n = 5; 2.7%). The mean hospital stay was 11 ± 6.5 days, and all-cause mortality after ten years was 14%. CONCLUSION Surgery represents the gold standard in treating primary cardiac tumors; in benign tumors, it is highly effective and curative, whereas, in malignant tumors, it remains associated with more prolonged survival.
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Affiliation(s)
- Christopher Gaisendrees
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Stephen Gerfer
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Charlotte Schröder
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Georg Schlachtenberger
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Sebastian Walter
- University Hospital Cologne, Department of Orthopaedics, Cologne, Germany
| | - Borko Ivanov
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Kaveh Eghbalzadeh
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Maximilian Lühr
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Ilija Djordjevic
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Parwis Rahmanian
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Navid Mader
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Ferdinand Kuhn-Régnier
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Thorsten Wahlers
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
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24
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Rahouma M, Baudo M, Dabsha A, Dimagli A, Mohamed A, Mick SL, Girardi L, Gaudino M, Lorusso R. Outcomes of Octogenarians with Primary Malignant Cardiac Tumors: National Cancer Database Analysis. J Clin Med 2022; 11. [PMID: 36013139 DOI: 10.3390/jcm11164899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/09/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Data concerning age-related populations affected with primary malignant cardiac tumors (PMCTs) are still scarce. The aim of the current study was to analyze mortality differences amongst different age groups of patients with PMCTs, as reported by the National Cancer Database (NCDB). The NCDB was retrospectively reviewed for PMCTs from 2004 to 2017. The primary outcome was late mortality differences amongst different age categories (octogenarian, septuagenarian, younger age), while secondary outcomes included differences in treatment patterns and perioperative (30-day) mortality. A total of 736 patients were included, including 72 (9.8%) septuagenarians and 44 (5.98%) octogenarians. Angiosarcoma was the most prevalent PMCT. Surgery was performed in 432 (58.7%) patients (60.3%, 55.6%, and 40.9% in younger age, septuagenarian, and octogenarian, respectively, p = 0.04), with a corresponding 30-day mortality of 9.0% (7.0, 15.0, and 38.9% respectively, p < 0.001) and a median overall survival of 15.7 months (18.1, 8.7, and 4.5 months respectively). Using multivariable Cox regression, independent predictors of late mortality included octogenarian, governmental insurance, CDCC grade II/III, earlier year of diagnosis, angiosarcoma, stage III/IV, and absence of surgery/chemotherapy. With increasing age, patients presented a more significant comorbidity burden compared to younger ones and were treated more conservatively. Early and late survival outcomes progressively declined with advanced age.
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25
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Markham LW, Johnson TR. Researching the Rare. JACC Cardiovasc Imaging 2022; 15:1406-1407. [PMID: 35926898 DOI: 10.1016/j.jcmg.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Larry W Markham
- Riley Children's Hospital at Indiana University Health, Indianapolis, Indiana, USA; Division of Pediatric Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
| | - Tiffanie R Johnson
- Riley Children's Hospital at Indiana University Health, Indianapolis, Indiana, USA; Division of Pediatric Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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26
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Rodríguez-Yánez T, Martínez-Ávila MC, Gutiérrez-Ariza JC, Almanza-Hurtado AJ, Cantillo-García K, Valencia-López J. Multimodality cardiac imaging in the diagnostic approach to chronic dyspnea: a patient with pericardial lipoma. Future Cardiol 2022; 18:673-677. [PMID: 35758139 DOI: 10.2217/fca-2022-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cardiac masses are rare entities that present with a very varied spectrum of manifestations ranging from asymptomatic to severe hemodynamic compromise. They mainly correspond to benign neoplastic lesions; however, other pathologies may occur. The availability of high-definition imaging techniques has increased early detection. Nevertheless, these techniques do not allow the characterization and reliable differentiation of the nature of the mass. We describe a patient with no cardiovascular history with a chronic dyspnea, in whom the presence of a cardiac mass attached to the ventricle with slight deformation of the right cavities was identified by imaging studies. The patient underwent surgical resection, which confirmed the presence of lipoma by histopathology. This finding is the rarest of all benign cardiac tumors.
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Affiliation(s)
| | - María C Martínez-Ávila
- Epidemiology & Public Health Department, BIOTOXAM group, Universidad de Cartagena, Cartagena, Colombia
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Kesiena O, Olokunlade T. The top 50 most cited articles on cardiac tumors: a bibliometric analysis. Future Cardiol 2022; 18:539-546. [PMID: 35735207 DOI: 10.2217/fca-2022-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We evaluated the characteristics of the top 50 most cited articles on cardiac tumors using bibliometric analysis. Method: Independent reviewers queried the Web of Science database for articles within the past 50 years. Results: Most articles were published between 1991 and 2016, 18% (9/50) of the first authors were women, 52% (26/50) of the articles were focused on cardiac imaging in addition to other aspects of cardiac tumors and only 61.5% (16/26) of these were focused purely on cardiac imaging. A journal's impact factor and the number of citations of an article were positively correlated, r(48) = 0.24, p = 0.048. Conclusion: This study presents insight into the top 50 most cited articles on cardiac tumors and provides guidance for future research.
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Affiliation(s)
- Onoriode Kesiena
- Department of Internal Medicine, Piedmont Athens Regional Medical Center, Athens, GA 30606, USA
| | - Temitope Olokunlade
- Department of Environmental & Occupational Health, School of Public Health, Texas A & M University, College Station, TX 77843, USA
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28
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Miwa K, Iwai S, Nagashima T. Management of neonatal cardiac rhabdomyoma obstructing the aortic valve. J Card Surg 2022; 37:2839-2841. [PMID: 35726654 DOI: 10.1111/jocs.16702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022]
Abstract
Rhabdomyomas associated with tuberous sclerosis are common cardiac tumors in children, and no surgical intervention is needed in most cases. However, when the tumor causes left ventricular outlet tract obstruction (LVOTO), immediate surgical intervention is indicated. Here, we report a newborn who was diagnosed antenatally with multiple cardiac rhabdomyomas, one of which blocked the aortic valve during systole. The tumor was resected early in the postnatal period with excellent outcomes. Until surgery, we maintained ductus arteriosus patency and systemic circulation using prostaglandin E1, which helped to reduce the risk of sudden death due to LVOTO. Postoperative two-dimensional echocardiography at discharge showed that surgery was effective in resolving LVOTO.
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Affiliation(s)
- Koji Miwa
- Department of Cardiovascular Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Shigemitsu Iwai
- Department of Cardiovascular Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Toshiaki Nagashima
- Department of Cardiovascular Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
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29
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Gaisendrees C, Gerfer S, Schlachtenberger G, Walter SG, Ivanov B, Merkle-Storms J, Mihaylova M, Sabashnikov A, Djordjevic I, Rahmanian P, Mader N, Kuhn-Régnier F, Wahlers T. Cardiac tumors-sex-related characteristics and outcomes after surgical resection. J Surg Oncol 2022; 126:823-829. [PMID: 35665932 DOI: 10.1002/jso.26971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/18/2022] [Accepted: 05/22/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Cardiac tumors represent a rare and heterogeneous pathological entity, with a cumulative incidence of up to 0.02%. Gender was previously reported to influence outcomes after tumor surgery. This study aimed to investigate for gender-related differences in outcomes after cardiac surgery. METHODS Between 2009 and 2021, 95 male and 88 female patients underwent surgery for tumor extirpation in our center. Preoperative baseline characteristics, intraoperative data, and long-term survival were analyzed. The diagnosis was confirmed postoperatively by (immune-)histopathological analysis. RESULTS There were no significant differences in baseline characteristics and survival. Myxoma was the most common tumor type overall and was more diagnosed in women (n = 36 vs. n = 62, p ≤ 0.001). Sarcoma was the most common malignant tumor type (n = 5). Tumor location at the atrial septum was more likely in women (n = 26 vs. n = 16, p = 0.041), whereas ventricular localization was more common in male patients (n = 20 vs. n = 7, p = 0.001). Minimally invasive tumor extirpation was significantly more often performed in women, and in-hospital stay was shorter in female patients. CONCLUSION The localization and dignity of cardiac tumors differ between genders, not affecting survival. Surgical tumor extirpation remains the gold standard of treatment for cardiac tumors in both genders as it is highly effective and associated with good long-term survivorship.
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Affiliation(s)
- Christopher Gaisendrees
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Stephen Gerfer
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Georg Schlachtenberger
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Sebastian G Walter
- Department of Orthopaedic Surgery and Traumatology, University Hospital Cologne, Cologne, Germany
| | - Borko Ivanov
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Julia Merkle-Storms
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Mariya Mihaylova
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Parwis Rahmanian
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Ferdinand Kuhn-Régnier
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
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Nenna A, Loreni F, Giacinto O, Chello C, Nappi P, Chello M, Nappi F. miRNAs in Cardiac Myxoma: New Pathologic Findings for Potential Therapeutic Opportunities. Int J Mol Sci 2022; 23:ijms23063309. [PMID: 35328730 PMCID: PMC8954653 DOI: 10.3390/ijms23063309] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 02/06/2023] Open
Abstract
MicroRNAs (miRNAs) regulate gene expression at the post-transcriptional level, contributing to all major cellular processes. The importance of miRNAs in cardiac development, heart function, and valvular heart disease has been shown in recent years, and aberrant expression of miRNA has been reported in various malignancies, such as gastric cancer and breast cancer. Different from other fields of investigation, the role of miRNAs in cardiac tumors still remains difficult to interpret due to the scarcity publications and a lack of narrative focus on this topic. In this article, we summarize the available evidence on miRNAs and cardiac myxomas and propose new pathways for future research. miRNAs play a part in modifying the expression of cardiac transcription factors (miR-335-5p), increasing cell cycle trigger factors (miR-126-3p), interfering with ceramide synthesis (miR-320a), inducing apoptosis (miR-634 and miR-122), suppressing production of interleukins (miR-217), and reducing cell proliferation (miR-218). As such, they have complex and interconnected roles. At present, the study of the complete mechanistic control of miRNA remains a crucial issue, as proper understanding of signaling pathways is essential for the forecasting of therapeutic implications. Other types of cardiac tumors still lack adequate investigation with regard to miRNA. Further research should aim at investigating the causal relationship between different miRNAs and cell overgrowth, considering both myxoma and other histological types of cardiac tumors. We hope that this review will help in understanding this fascinating molecular approach.
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Affiliation(s)
- Antonio Nenna
- Cardiac Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (A.N.); (F.L.); (O.G.); (M.C.)
| | - Francesco Loreni
- Cardiac Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (A.N.); (F.L.); (O.G.); (M.C.)
| | - Omar Giacinto
- Cardiac Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (A.N.); (F.L.); (O.G.); (M.C.)
| | - Camilla Chello
- Integrated Biomedical Science and Bioethics, Università Campus Bio-Medico di Roma, 00128 Rome, Italy;
| | - Pierluigi Nappi
- Cardiology, Università degli Studi di Messina, 98122 Messina, Italy;
| | - Massimo Chello
- Cardiac Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (A.N.); (F.L.); (O.G.); (M.C.)
| | - Francesco Nappi
- Cardiac Surgery, Centre Cardiologique du Nord de Saint Denis, 93200 Paris, France
- Correspondence: ; Tel.: +33-149334104; Fax: +33-149334119
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31
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Salem M, Hillmer J, Friedrich C, Panholzer B, Saad M, Salem M, Frank D, Ernst M, Maetzler W, Puehler T, Lutter G, Schoeneich F, Haneya A, Cremer J, Schoettler J. Cardiac Myxomas Resembling Malignant Neoplasia: Incidentally Diagnosed vs. Cerebral Embolized Myxomas. Cancers (Basel) 2022; 14:cancers14051111. [PMID: 35267419 PMCID: PMC8909683 DOI: 10.3390/cancers14051111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Cardiac myxomas (CM) are the most common primary cardiac tumors in adults. They are usually benign; however, malignant changes are known to occur but are extremely rare. Embolization is a common complication of cardiac myxomas and can cause neurological deficits before their surgical removal. The current study analyzed the outcomes after operative myxoma excision in patients, with and without cerebral embolic events prior to excision. Methods: All 66 consecutive patients who underwent a surgical excision of CM between 2005 and 2019 at our department were analyzed retrospectively. Patients with (n = 14) and without (n = 52) preoperative strokes caused by cerebral tumor embolization were compared. Results: The mean age was 58.4 ± 12.7 years in the stroke group (SG) and 62.8 ± 11.7 years in the non-stroke group (N-SG) (p = 0.226). Gender (35.7% vs. 61.5% female; p = 0.084) did not differ significantly, and comorbidities were comparable in both groups. The left hemisphere in the territory of the middle cerebral artery was affected by preoperative cerebral infarction most commonly (28.6%). The time from diagnosis to cardiac surgery procedure was 7 (3−24) days in the SG and 23 (5−55) days in the N-SG (p = 0.120). Cardiac myxomas were localized in the left atrium in both groups more frequently (SG: 92.9% vs. N-SG: 78.8%; p = 0.436). In the SG, 57.1% of CM had a non-solid surface, were localized in the left heart, and had a pedunculated attachment away from the fossa ovalis. In the N-SG, 92.3% of CM did not meet all these criteria (p < 0.001). The maximal diameters of CM were comparable (SG: 3.4 ± 1.5 cm vs. N-SG: 3.8 ± 2.1 cm; p = 0.538). The operation times (192.5 (139.3−244.5) min vs. 215.5 (184.5−273.3) min; p = 0.046) and the cross-clamp times (54.5 (33.3−86.5) min vs. 78.5 (55−106.8) min; p = 0.035) were significantly shorter in the SG. Only in the N-SG were reconstructions of the endocardium with bovine pericardium required after resection (51.9% vs 0%; p < 0.001). In the N-SG, CM were explored via the right atrium more often (57.7% vs. 14.3%; p = 0.007). Patients in the N-SG required significantly shorter ICU care after surgery (p = 0.020). Other postoperative courses did not differ significantly. After tumor removal, 1.9% of the N-SG suffered their first stroke and 14.3% of the SG had a cerebral re-infarction (p = 0.111). The 30-day mortality rates were 1.9% in the N-SG and 7.1% in the SG (p = 0.382). In one case in the N-SG, a tumor recurrence was diagnosed. The Kaplan−Meiercurves showed a significantly better long-term prognosis for patients in the N-SG (p = 0.043). Conclusions: After the surgical removal of CM, the outcome is compromised if preoperative cerebral embolization occurs. Surgical treatment is therefore indicated as soon as possible, especially when CM have a non-solid surface, are localized in the left heart, and have a pedunculated attachment away from the fossa ovalis.
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Affiliation(s)
- Mohamed Salem
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
- Correspondence: ; Tel.: +49-(0431)-500-67089; Fax: +49-(0431)-500-22004
| | - Jonas Hillmer
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Christine Friedrich
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Bernd Panholzer
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Mohammed Saad
- Department of Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.S.); (M.S.); (D.F.)
| | - Mostafa Salem
- Department of Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.S.); (M.S.); (D.F.)
| | - Derk Frank
- Department of Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.S.); (M.S.); (D.F.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Markus Ernst
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Walter Maetzler
- Department of Neurology, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany;
| | - Thomas Puehler
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Georg Lutter
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Felix Schoeneich
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Assad Haneya
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Jochen Cremer
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Jan Schoettler
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
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Abstract
Primary cardiac lymphoma (PCL) is a rare entity that comprises only 1-2% of all cardiac tumors. Due to their scarcity and variable clinical presentation, early diagnosis is challenging. In this series, three cases of PCL from a single institution are described, which highlight the spectrum of presenting features and emphasize common principles. In the first case, a 73-year-old male who presented with dyspnea was found to have a 12.1 cm mass in the right ventricle. Biopsy via cardiac catheterization revealed diffuse large B cell lymphoma (DLBCL). He was treated with chemoimmunotherapy and survived for two months. The second case describes a 55-year-old female who presented with chest pain. Imaging revealed a 3.1 cm right atrial mass and bilateral pleural effusions, with cytology from the latter demonstrating DLBCL. She was lost to follow up after three cycles of chemoimmunotherapy. In the last case, an 80-year-old female presented with weakness. A 4.0 cm mass was discovered in the right atrium and the patient expired shortly after admission. Autopsy confirmed the diagnosis of DLBCL. These case summaries are followed by a review of the clinical presentation, diagnostic approach, and treatment outcomes of PCL.
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Affiliation(s)
| | - Zohar Sachs
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Zuzan Cayci
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Lihong Bu
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Michael Andrew Linden
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
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33
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Wu HH, Wang LH, Li HY. Isolated metastasis of mediastinal carcinoid to the left ventricle: A case report. Echocardiography 2021; 38:2091-2094. [PMID: 34806221 DOI: 10.1111/echo.15253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/11/2021] [Accepted: 10/28/2021] [Indexed: 11/26/2022] Open
Abstract
Carcinoid tumors are uncommon neuroendocrine tumors that produce high levels of serotonin and are mainly located in the gastrointestinal tract and bronchopulmonary system but very rarely in the mediastinum. These are slow-growing tumors that most commonly present metastatic lesions in the liver, followed by the bones, lungs, and peritoneum. Solid cardiac metastases from carcinoid tumors have seldom been reported. In this case report, we present a patient with a rare localized metastasis in the left ventricle with an antecedent history of resected carcinoid tumor of the anterior mediastinum.
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Affiliation(s)
- Hui-Hui Wu
- Department of Echocardiography, Yuhuangding Hospital,Qingdao University, Yantai, China
| | - Li-Hong Wang
- Department of Echocardiography, Yuhuangding Hospital,Qingdao University, Yantai, China
| | - Hong-Yan Li
- Department of Pharmacy, Yuhuangding Hospital, Qingdao University, Yantai, China
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34
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Pearman JL, Wall SL, Chen L, Rogers JH. Intracardiac echocardiographic-guided right-sided cardiac biopsy: Case series and literature review. Catheter Cardiovasc Interv 2021; 98:1000-1005. [PMID: 33002282 DOI: 10.1002/ccd.29302] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/26/2020] [Accepted: 09/16/2020] [Indexed: 11/06/2022]
Abstract
Endomyocardial biopsy (EMB) is a common procedure used to aid in the diagnosis of diffuse myocardial diseases and, less commonly, in the diagnosis of cardiac tumors. As cardiac tumors are often found in high-risk locations (ventricular free wall or atria), precision biopsy is paramount, and additional imaging, like transesophageal echocardiography is often required for guidance. The use of intracardiac echocardiography (ICE) to guide biopsy has been described, but there is no consensus on a standardized approach. We report our institutional approach with three cases of ICE-directed EMB performed with the 2.4 mm Jawz bioptome directed with an 8.5-Fr Agilis NxT steerable introducer. All cases were performed under guidance with the AcuNav ICE probe. There were no procedural complications and a definitive diagnosis was obtained in all three cases. We also review the available published cases of ICE-guided EMB in the literature-noting the different procedural approaches, complication rate, and diagnostic yield. There were only two negative biopsies reported among the published cases and no reported complications. Our review of all these cases suggests that ICE-guidance for EMB is superior to other forms of imaging in its ease of use and high definition of right-sided cardiac structures. We also feel that the use of the Agilis steerable sheath allows for more precise directing of the bioptome and is a critical component in performing a successful targeted biopsy.
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Affiliation(s)
- Joseph L Pearman
- Internal Medicine, UC Davis Medical Center, Sacramento, California
| | - Stephen L Wall
- Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California
| | - Lily Chen
- Internal Medicine, UC Davis Medical Center, Sacramento, California.,Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California
| | - Jason H Rogers
- Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California
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35
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Cheang S, Samples S. Congenital Solitary Left Atrial Mass. World J Pediatr Congenit Heart Surg 2021; 12:654-655. [PMID: 34597202 DOI: 10.1177/21501351211031890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rhabdomyoma in the absence of tuberous sclerosis presenting as a large solitary atrial mass is an atypical finding. We hereby present images from an infant with a fetally diagnosed large left atrial mass with no evidence of mitral valve dysfunction who subsequently developed persistent arrhythmias requiring surgical resection of the mass in the neonatal period.
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Affiliation(s)
- Stefanie Cheang
- Department of Pediatric Cardiology, Children's Hospital New Orleans, Louisiana State University Health Sciences Center, LA, USA
| | - Stefani Samples
- Department of Pediatric Cardiology, Children's Hospital New Orleans, Louisiana State University Health Sciences Center, LA, USA
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Bahloul A, Sarray H, Kammoun Y, Charfeddine S, Gueldich M, Dammak A, Frikha I, Abid L, Hammami R, Kammoun S. Giant Left Atrial Myxoma with Mitral Valve Obstruction. J Cardiovasc Echogr 2021; 31:110-112. [PMID: 34485040 PMCID: PMC8388329 DOI: 10.4103/jcecho.jcecho_111_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/08/2021] [Accepted: 03/29/2021] [Indexed: 11/25/2022] Open
Abstract
Cardiac myxomas are the most common primary intracardiac tumors in adults. Although benign from a histopathological point of view, they can be life-threatening for the patient. We present a case of an unusually giant left atrial myxoma causing mitral valve obstruction and pulmonary hypertension successfully treated with surgical resection. Our patient was a 54-year-old woman who presented to our emergency complaining of progressive dyspnea of about 1 month duration. On cardiovascular examination, we found crackling rales at both lung bases and a diastolic murmur in the mitral focus. Transthoracic echocardiography revealed a giant mass in the left atrium connected to the interatrial septum and extended into the left ventricle during diastole which caused obstruction of the left ventricular inflow tract and a pulmonary hypertension. The patient underwent a median sternotomy with the removal of left atrial mass and patch closure of the interatrial septum. Histopathological examination confirmed the diagnosis of myxoma. One week later, the patient was discharged without any complications. Giant left atrial myxoma although a benign mass, can induce dramatic symptoms and be life-threatening. In case of suspicion, it must be diagnosed early by transthoracic echocardiography and urgently managed by surgical removal.
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Affiliation(s)
- Amine Bahloul
- Department of Cardiology, Hedi Chaker Hospital, Sfax University, Sfax, Tunisia
| | - Hela Sarray
- Department of Cardiology, Hedi Chaker Hospital, Sfax University, Sfax, Tunisia
| | - Yassmine Kammoun
- Department of Cardiology, Hedi Chaker Hospital, Sfax University, Sfax, Tunisia
| | - Selma Charfeddine
- Department of Cardiology, Hedi Chaker Hospital, Sfax University, Sfax, Tunisia
| | - Majdi Gueldich
- Department of Cardiovascular Surgery, Habib Bourguiba Hospital, Sfax University, Sfax, Tunisia
| | - Aymen Dammak
- Department of Cardiovascular Surgery, Habib Bourguiba Hospital, Sfax University, Sfax, Tunisia
| | - Imed Frikha
- Department of Cardiovascular Surgery, Habib Bourguiba Hospital, Sfax University, Sfax, Tunisia
| | - Leila Abid
- Department of Cardiology, Hedi Chaker Hospital, Sfax University, Sfax, Tunisia
| | - Rania Hammami
- Department of Cardiology, Hedi Chaker Hospital, Sfax University, Sfax, Tunisia
| | - Samir Kammoun
- Department of Cardiology, Hedi Chaker Hospital, Sfax University, Sfax, Tunisia
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Masiello P, Catalano A, Mastrogiovanni G, Eusebio G, De Roberto AM, Chivasso P, Ciancia G, Iesu I, Triggiani D, Iesu S. Surgical removal of an exceedingly rare papillary fibroelastoma of the aortic wall causing unstable angina. Clin Case Rep 2021; 9:e04688. [PMID: 34484752 PMCID: PMC8405373 DOI: 10.1002/ccr3.4688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/27/2021] [Accepted: 07/23/2021] [Indexed: 11/11/2022] Open
Abstract
Difficult diagnosis is due to rarity of the case. TT or TE echocardiography is sufficient to make a correct diagnosis. The risk of embolism or coronary ostia occlusion should guide the decision for surgery.
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Affiliation(s)
- Paolo Masiello
- Emergency Cardiac SurgeryCardio‐Thoracic and Vascular DepartmentUniversity Hospital “San Giovanni di Dio e Ruggi D’Aragona”SalernoItaly
| | - Angelo Catalano
- Cardiology DivisionEmergency Department Eboli‐Battipaglia‐RoccadaspideMaria SS Addolorata General HospitalEboliItaly
| | - Generoso Mastrogiovanni
- Emergency Cardiac SurgeryCardio‐Thoracic and Vascular DepartmentUniversity Hospital “San Giovanni di Dio e Ruggi D’Aragona”SalernoItaly
| | - Geppina Eusebio
- Cardiology DivisionEmergency Department Eboli‐Battipaglia‐RoccadaspideMaria SS Addolorata General HospitalEboliItaly
| | - Anna Maria De Roberto
- Cardiology DivisionEmergency Department Eboli‐Battipaglia‐RoccadaspideMaria SS Addolorata General HospitalEboliItaly
| | - Pierpaolo Chivasso
- Emergency Cardiac SurgeryCardio‐Thoracic and Vascular DepartmentUniversity Hospital “San Giovanni di Dio e Ruggi D’Aragona”SalernoItaly
| | - Giuseppe Ciancia
- Pathological Anatomy and HistologyOnco‐Hematological DepartmentUniversity Hospital “San Giovanni di Dio e Ruggi D’Aragona”SalernoItaly
| | - Ivana Iesu
- Clinical Cardiology DivisionCardio‐Thoracic‐Vascular Department“San Giovanni di Dio e Ruggi D’Aragona” University Hospital of SalernoSalernoItaly
| | - Donato Triggiani
- Emergency Cardiac SurgeryCardio‐Thoracic and Vascular DepartmentUniversity Hospital “San Giovanni di Dio e Ruggi D’Aragona”SalernoItaly
| | - Severino Iesu
- Emergency Cardiac SurgeryCardio‐Thoracic and Vascular DepartmentUniversity Hospital “San Giovanni di Dio e Ruggi D’Aragona”SalernoItaly
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38
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Mhadgut H, Manthri S, Youssef B, Jaishankar D. The Rarest of the Rare: A Case of Primary Cardiac Osteosarcoma With a Review of the Literature. Cureus 2021; 13:e16492. [PMID: 34430107 PMCID: PMC8373439 DOI: 10.7759/cureus.16492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/05/2022] Open
Abstract
A 54-year-old female presented with shortness of breath and cyanosis. Work up with chest X-ray and subsequent echocardiogram revealed an intracardiac bi-atrial mass leading to emergent cardiothoracic resection. Pathology was consistent with a primary cardiac high-grade osteosarcoma. Post-resection staging positron emission tomography-computed tomography (PET-CT) showed hypermetabolic mixed lytic and sclerotic lesion of T10 concerning for metastasis. She received five cycles of adriamycin and ifosfamide chemotherapy before discontinuation due to systolic dysfunction. Nine months later, she developed a high tumor burden with progressive disease and was treated with second-line gemcitabine/docetaxel with disappointing results. She is currently on treatment with cyclophosphamide and topotecan as third-line treatment with an excellent clinico-radiographic response. Osteosarcomas are aggressive with a high incidence of recurrence and metastasis. Fewer than 50 cases of primary cardiac osteosarcomas have been reported in the literature. Even though complete resection can be achieved in some cases, long-term results are usually poor. No standard therapy has been established.
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Affiliation(s)
- Hemendra Mhadgut
- Medical Oncology, East Tennessee State University, Johnson City, USA
| | - Sukesh Manthri
- Medical Oncology, East Tennessee State University, Johnson City, USA
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Heaton JN, Dhaduk N, Okoh AK, Dang-Ho KP, Tayal R, Salemi A, Waxman S. Characteristics, management, and outcomes among admissions for primary cardiac tumors: Results from the National Inpatient Sample. J Card Surg 2021; 36:3586-3592. [PMID: 34314042 DOI: 10.1111/jocs.15862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Primary cardiac tumors (PCT) are rare, and their contemporary outcomes are not well characterized in the literature. We assessed temporal trends in patient characteristics and management of admissions for PCT in US hospitals. METHODS Admissions with the principal diagnoses of a PCT (benign neoplasm of heart: ICD-9 212.7, ICD-10 D15.1; malignant neoplasm of heart: ICD-9 164.1, ICD-10 C38.0) between 2006 and 2017 were extracted from the National Inpatient Sample. Trends in demographics and clinical profiles were evaluated. We conducted descriptive analyses on the cohort and compared outcomes between those managed medically and surgically. RESULTS Between 2006 and 2017, 19,111 admissions had the primary diagnosis of a PCT. Of these, 91.1% were benign. Admissions were mostly female (65.0%), caucasian (72.0%), and aged more than 50 years (76.0%). The annual admission rate for PCT was similar from 2006 to 2017 (p trend > .05) and associated with congestive heart failure, diabetes, renal failure, and valvular lesions. PCTs were managed surgically in 12,811 (67.0%) of overall cases, 70.8% for benign and 28.3% for malignant tumors. Overall, the in-hospital mortality rate was 2.3%. Medically managed cases reported a 2.5% higher mortality (p < .001) than those surgically managed. Admissions with malignant tumors were more likely to expire during hospitalization than those with benign tumors (odds ratio, 9.75; 95% confidence interval 6.34-14.99; p < .001). CONCLUSION Admissions for primary cardiac tumors were primarily women or in their fifth or sixth decade of life. Surgical intervention is more commonly practiced and is associated with better in-hospital survival.
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Affiliation(s)
- Joseph N Heaton
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA.,Division of Cardiology, Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, New Jersey, USA
| | - Nehal Dhaduk
- Division of Cardiology, Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, New Jersey, USA
| | - Alexis K Okoh
- Division of Cardiology, Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, New Jersey, USA
| | - Khoi P Dang-Ho
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Rajiv Tayal
- Division of Cardiology, Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, New Jersey, USA
| | - Arash Salemi
- Division of Cardiology, Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, New Jersey, USA
| | - Sergio Waxman
- Division of Cardiology, Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, New Jersey, USA
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Matteucci M, Ferrarese S, Mantovani V, Ronco D, Torchio F, Franzosi C, Marazzato J, De Ponti R, Lorusso R, Beghi C. Surgical treatment of primary cardiac tumors in the contemporary era: A single-centre analysis. J Card Surg 2021; 36:3540-3546. [PMID: 34254361 PMCID: PMC8518736 DOI: 10.1111/jocs.15813] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/16/2021] [Accepted: 07/05/2021] [Indexed: 12/18/2022]
Abstract
Background Primary cardiac tumors (PCT) are rare lesions but have the potential to cause significant morbidity if not timely treated. We reviewed our single‐center experience in the surgical treatment of PCT with a focus on the long‐term outcome. Methods From 2001 to 2020, 57 consecutive patients underwent surgical resection of PCT at our Institution. Data including the demographic characteristics, tumor histology, surgical procedure, and postoperative outcomes were collected and analyzed. Results Mean age at presentation was 63.6 ± 11.2 years, and 33 (57.9%) of the patients were female. A total of 55 (96.5%) subjects were diagnosed with benign cardiac tumor, while the remaining had malignant tumors. The most common histopathological type was myxoma. All patients survived to hospital discharge. Main postoperative complications were: acute kidney injury (n = 3), sepsis (n = 3), and stroke (n = 2). Mean follow‐up time was 9 ± 5.9 years. Long‐term mortality was 22.8% (13/57). No tumor recurrence was observed among survivors. There was a significant relationship between mortality and pathological characteristics of the tumor, and myxomas had higher survival rates. Conclusion Surgical treatment of PCT is a safe and highly effective strategy associated with excellent short‐term outcomes. Long‐term survival remains poor for primary malignant tumors of the heart.
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Affiliation(s)
- Matteo Matteucci
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy.,Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sandro Ferrarese
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Vittorio Mantovani
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Daniele Ronco
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Federica Torchio
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Cinzia Franzosi
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Jacopo Marazzato
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Roberto De Ponti
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Cesare Beghi
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
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41
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Pungsornruk K, Cusimano RJ, Foley K, Djaiani G. Right-Sided Cardiac Tumors and Awake Femoro-femoral Bypass. J Cardiothorac Vasc Anesth 2021; 36:2055-2059. [PMID: 34215523 DOI: 10.1053/j.jvca.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Karla Pungsornruk
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Robert James Cusimano
- Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Karen Foley
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - George Djaiani
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.
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42
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Restivo L, De Luca A, Pinamonti B, Grilli G, Bussani R, Cominotto F, Crisafulli C, Dore F, Sinagra G, Pappalardo A. A case of primary cardiac sarcoma with an acute presentation: The role of multimodality imaging. Clin Case Rep 2021; 9:e04219. [PMID: 34178334 PMCID: PMC8212016 DOI: 10.1002/ccr3.4219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/12/2022] Open
Abstract
The case highlights the value of contrast echocardiography in raising clinical suspicion of malignancy, allowing a diagnostic work-up and the treatment of the primitive heart tumors.
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Affiliation(s)
- Luca Restivo
- Division of CardiologyCardiothoracovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Antonio De Luca
- Division of CardiologyCardiothoracovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Bruno Pinamonti
- Division of CardiologyCardiothoracovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Giulia Grilli
- Division of CardiologyCardiothoracovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Rossana Bussani
- Pathology DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Franco Cominotto
- Emergency Medicine DepartmentAzienda Sanitaria Universitaria Giuliano‐IsontinaTriesteItaly
| | - Carmelo Crisafulli
- Nuclear Medicine DepartmentAzienda Sanitaria Universitaria Giuliano‐IsontinaTriesteItaly
| | - Franca Dore
- Nuclear Medicine DepartmentAzienda Sanitaria Universitaria Giuliano‐IsontinaTriesteItaly
| | - Gianfranco Sinagra
- Division of CardiologyCardiothoracovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Aniello Pappalardo
- Division of Cardiac SurgeryCardiovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐IsontinaTriesteItaly
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Seferović PM, Tsutsui H, Mcnamara DM, Ristić AD, Basso C, Bozkurt B, Cooper LT, Filippatos G, Ide T, Inomata T, Klingel K, Linhart A, Lyon AR, Mehra MR, Polovina M, Milinković I, Nakamura K, Anker SD, Veljić I, Ohtani T, Okumura T, Thum T, Tschöpe C, Rosano G, Coats AJS, Starling RC. Heart Failure Association, Heart Failure Society of America, and Japanese Heart Failure Society Position Statement on Endomyocardial Biopsy. J Card Fail 2021; 27:727-743. [PMID: 34022400 DOI: 10.1016/j.cardfail.2021.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Endomyocardial biopsy (EMB) is an invasive procedure, globally most often used for the monitoring of heart transplant rejection. In addition, EMB can have an important complementary role to the clinical assessment in establishing the diagnosis of diverse cardiac disorders, including myocarditis, cardiomyopathies, drug-related cardiotoxicity, amyloidosis, other infiltrative and storage disorders, and cardiac tumors. Improvements in EMB equipment and the development of new techniques for the analysis of EMB samples has significantly improved the diagnostic precision of EMB. The present document is the result of the Trilateral Cooperation Project between the Heart Failure Association of the European Society of Cardiology, Heart Failure Society of America, and the Japanese Heart Failure Society. It represents an expert consensus aiming to provide a comprehensive, up-to-date perspective on EMB, with a focus on the following main issues: (1) an overview of the practical approach to EMB, (2) an update on indications for EMB, (3) a revised plan for heart transplant rejection surveillance, (4) the impact of multimodality imaging on EMB, and (5) the current clinical practice in the worldwide use of EMB.
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Affiliation(s)
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Dennis M Mcnamara
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arsen D Ristić
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Biykem Bozkurt
- Winters Center for Heart Failure, Cardiovascular Research Institute, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Gerasimos Filippatos
- Attikon University Hospital, Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital, Tuebingen, Germany
| | - Aleš Linhart
- Department of Cardiovascular Medicine, Charles University, Prague, Czech Republic
| | - Alexander R Lyon
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK
| | - Mandeep R Mehra
- Heart and Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Marija Polovina
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Milinković
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Ivana Veljić
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany; Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Carsten Tschöpe
- Berlin Institute of Health (BIH) and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Department of Cardiology, Campus Virchow Klinikum, Charite University, Berlin, Germany
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele, Rome, Italy, and Cardiology Clinical Academic Group, St George's Hospitals NHS Trust
| | - Andrew J S Coats
- Monash University, Australia, and University of Warwick, Coventry, UK
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Spiliopoulos K, Anyfantakis ZA, Diminikos I, Xanthopoulos A, Magouliotis DE, Skoularigis J, Triposkiadis F. Acute myocardial infarction not attributed to coronary artery disease: A seldom initial presentation of a left ventricular myxoma. Clin Case Rep 2021; 9:e04029. [PMID: 34084484 PMCID: PMC8142312 DOI: 10.1002/ccr3.4029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/22/2021] [Accepted: 02/18/2021] [Indexed: 12/02/2022] Open
Abstract
Although myxoma represents the most frequent non-malignant cardiac primary tumor; it is extremely rare met in the left ventricle. Clinical features of the neoplasm extend from symptomless to critical signs of either ischemia or embolism. We describe here an unusual case of a huge left ventricular myxoma in a 68-year-old man, presented with clinical and ECG findings of an inferior wall myocardial infarction. The patient was primarily referred to our institution for coronary angiography, which showed no coronary artery disease. Further examinations revealed a left ventricular mass as the possible source of embolization, thus the patient underwent surgery for tumor excision. The postoperative course was unremarkable. A bibliographical analysis demonstrated that those tumors are rare but treatable causes of embolic myocardial infarction, thus profound clinical intuition, proper utilization of imaging modalities, administration of anticoagulants preoperatively, as well immediate surgical removal are justified.
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Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Thoracic and Cardiovascular SurgeryFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
| | - Zacharias A. Anyfantakis
- Department of CardiologyFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
| | - Ilias Diminikos
- Department of CardiologyFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
| | - Andrew Xanthopoulos
- Department of CardiologyFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
| | - Dimitrios E. Magouliotis
- Department of SurgeryFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
| | - John Skoularigis
- Department of CardiologyFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
| | - Filippos Triposkiadis
- Department of CardiologyFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
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Karpathiou G, Dumollard JM, Camy F, Sramek V, Dridi M, Picot T, Mobarki M, Peoc'h M. Senescence, immune microenvironment, and vascularization in cardiac myxomas. Cardiovasc Pathol 2021; 52:107335. [PMID: 33762213 DOI: 10.1016/j.carpath.2021.107335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/16/2021] [Accepted: 03/15/2021] [Indexed: 12/14/2022] Open
Abstract
AIMS Cardiac myxomas are rare tumors of incompletely elucidated pathogenesis. The aim of this study is to explore the possible presence of a senescence phenotype in cardiac myxomas, associated with an inflammatory and vasculogenic tumor microenvironment. METHODS AND RESULTS This is a retrospective study of 29 cardiac myxomas with immunohistochemical detection of various inflammatory, vascular, and senescence markers. We show that all myxomas contain tumor cells in senescence overexpressing p16, and a fraction of senescent endothelial cells. Macrophages are the principal inflammatory cell population, followed by cytotoxic T cells, with fewer plasma cells, mastocytes, and B lymphocytes. These populations are found in different intratumoral localizations. Larger tumor volume is associated with a lower percentage of myxoid matrix, higher cellularity, higher macrophage, and lower number of mast cells as well as higher PD-L1 expression by inflammatory cells. Higher vascular density is associated with higher percentage of B cells, a lower number of macrophages and higher number of mastocytes, and lower PD-L1 expression by inflammatory cells. Tumors with higher vascular density and higher cellularity show higher amounts of p16 senescent endothelial cells. CONCLUSIONS Myxoma tumor cells are in senescence and reside inside a tumor microenvironment with a distinct inflammatory profile rich in macrophages and cytotoxic T cells, and a rich vasculature, probably attributed to a senescence-associated secretory phenotype.
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Affiliation(s)
- Georgia Karpathiou
- Pathology Department, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France.
| | - Jean Marc Dumollard
- Pathology Department, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Florian Camy
- Pathology Department, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Viviana Sramek
- Pathology Department, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Maroa Dridi
- Pathology Department, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Tiphanie Picot
- Pathology Department, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Mousa Mobarki
- Pathology Department, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France; Faculty of Medicine, Jazan University, Jazan, Saudi Arabia; Pathology Department, East Hospital, University Hospital of Lyon, Lyon, France
| | - Michel Peoc'h
- Pathology Department, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
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Abstract
Primary cardiac tumours for which surgical resection is the main stay of treatment are rare and present both diagnostic and management challenges. The majority of patients are asymptomatic and one third of those who have symptoms present with vague constitutional symptoms which further complicates the process of early diagnosis. The current state-of-the art multi-modality imaging, routine use of intra-operative transoesophageal echocardiogram (TOE) in most cardiac centres and the tremendous advances of endoscopic adjuncts greatly enhances both the diagnosis and management of those group of patients. The surgical burden of median sternotomy and the contemporary trend towards less invasive surgery urged the necessity for adopting minimally invasive surgery in general and cardiac tumours are no exception. Despite the rarity of theses tumours, minimally invasive resection is successful in the hands of experienced minimally invasive surgeons who employ the same minimal access valve surgery platform to access the tumours in various cardiac chambers and valves with no compromise to the oncological clearance and hence achieve the benefits of minimally invasive surgery without compromising long term outcomes.
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Affiliation(s)
- Ayman Kenawy
- Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Teaching Hospital, Blackpool, UK
| | - Abdelrahman Abdelbar
- Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Teaching Hospital, Blackpool, UK
| | - Joseph Zacharias
- Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Teaching Hospital, Blackpool, UK
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47
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Awad A, Gibbons DS, Hussein H, Mohamed S, Mohammed S. Giant Left Ventricular Papillary Fibroelastoma Presented as Transient Ischemic Attack and Complicated by Post-Pericardiotomy Syndrome. Cureus 2021; 13:e12634. [PMID: 33447496 PMCID: PMC7802604 DOI: 10.7759/cureus.12634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Papillary fibroelastoma is a benign cardiac tumour that most commonly presents as an incidental finding on imaging but may present with an acute neurological event due to embolic phenomena. We report a 51-year-old female who presented with focal neurology of the right hand that lasted for 30 minutes. Her initial investigations including CT-brain were unremarkable, and given her low-risk profile for stroke she was discharged for routine outpatient workup of possible transient ischaemic attack. Transthoracic echo detected a large mobile mass attached to the left ventricular wall. This was mistakenly diagnosed as a left ventricular thrombus, for which she was commenced on warfarin. After three months on warfarin without reduction in the size of the mass, cardiac MRI was performed. The scan was repeated as the initial imaging failed to demonstrate the tumour. This was followed by positron emission tomography which suggested a benign mass of the left ventricle. The patient underwent surgical excision of the tumour and developed post-pericardiotomy syndrome. Histopathology confirmed papillary fibroelastoma. Though rare, cardiac neoplasm may remain a differential diagnosis for acute neurological presentations in non-classical patients.
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Affiliation(s)
- Alaa Awad
- Internal Medicine, Royal College of Surgeons Hospitals Group, Cavan General Hospital, Cavan, IRL
| | - Daire-Sean Gibbons
- Internal Medicine, Royal College of Surgeons Hospitals Group, Cavan General Hospital, Cavan, IRL
| | | | - Sarra Mohamed
- Internal Medicine, Royal College of Surgeons Hospitals Group, Cavan General Hospital, Cavan, IRL
| | - Sara Mohammed
- Internal Medicine, Royal College of Surgeons Hospitals Group, Cavan General Hospital, Cavan, IRL
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48
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Sultan I, Bianco V, Habertheuer A, Kilic A, Gleason TG, Aranda-Michel E, Harinstein ME, Martinez-Meehan D, Arnaoutakis G, Okusanya O. Long-Term Outcomes of Primary Cardiac Malignancies: Multi-Institutional Results From the National Cancer Database. J Am Coll Cardiol 2020; 75:2338-47. [PMID: 32381166 DOI: 10.1016/j.jacc.2020.03.041] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Data on primary cardiac malignancies are limited to small single-center studies. OBJECTIVES The aim of the current study was to provide detailed outcomes for treatment of primary cardiac malignancies from a multi-institutional database. METHODS Outcomes were acquired from the National Cancer Database for all solid primary cardiac malignancies from 2004 to 2016. The primary outcome was long-term survival. Logistic regression was used to determine factors associated with mortality. RESULTS A total of 100,317 cardiac tumors were identified, of which 826 (0.8%) were primary malignant tumors. After exclusion criteria, the cohort consisted of 747 patients (median age 53 years, 47.5% women). Most tumors were primary sarcomas (88.5%), the majority of which were hemangiosarcoma (40.4%). A total of 136 patients received no therapy, 113 received just chemotherapy, and 20 received just radiation. Surgery was performed in 442 (59.2%) patients including 255 patients undergoing multimodal therapy (surgery with chemotherapy, radiation, or chemoradiation). With surgery alone, 90-day mortality was 29.4%. Overall 30-day, 1-year, and 5-year survival rates were 81.2%, 45.3%, and 11.5%, respectively. The surgery group as compared with the no surgery groups had significantly better long-term survival (p < 0.0001). For stage III disease, there was a statistically significant improvement in survival with the addition of chemotherapy to surgery. CONCLUSIONS Primary cardiac malignancies are rare cancers with dismal long-term survival despite mode of treatment. Patients who underwent surgery and those with stage III disease who received peri-operative chemotherapy had better survival compared with those who did not. However, there was likely a significant selection bias in patients chosen for surgical or medical therapy.
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49
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Aggeli C, Dimitroglou Y, Raftopoulos L, Sarri G, Mavrogeni S, Wong J, Tsiamis E, Tsioufis C. Cardiac Masses: The Role of Cardiovascular Imaging in the Differential Diagnosis. Diagnostics (Basel) 2020; 10:diagnostics10121088. [PMID: 33327646 PMCID: PMC7765127 DOI: 10.3390/diagnostics10121088] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 02/06/2023] Open
Abstract
Cardiac masses are space occupying lesions within the cardiac cavities or adjacent to the pericardium. They include frequently diagnosed clinical entities such as clots and vegetations, common benign tumors such as myxomas and papillary fibroelastomas and uncommon benign or malignant primary or metastatic tumors. Given their diversity, there are no guidelines or consensus statements regarding the best diagnostic or therapeutic approach. In the past, diagnosis used to be made by the histological specimens after surgery or during the post-mortem examination. Nevertheless, evolution and increased availability of cardiovascular imaging modalities has enabled better characterization of the masses and the surrounding tissue. Transthoracic echocardiography using contrast agents can evaluate the location, the morphology and the perfusion of the mass as well as its hemodynamic effect. Transesophageal echocardiography has increased spatial and temporal resolution; hence it is superior in depicting small highly mobile masses. Cardiac magnetic resonance and cardiac computed tomography are complementary providing tissue characterization. The scope of this review is to present the role of cardiovascular imaging in the differential diagnosis of cardiac masses and to propose a step-wise diagnostic algorithm, taking into account the epidemiology and clinical presentation of the cardiac masses, as well as the availability and the incremental value of each imaging modality.
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Affiliation(s)
- Constantina Aggeli
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
- Correspondence:
| | - Yannis Dimitroglou
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
| | - Leonidas Raftopoulos
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
| | - Georgia Sarri
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
| | - Sophie Mavrogeni
- Department of Cardiology, Onassis Cardiac Surgery Centre, 17674 Kallithea, Attica, Greece;
| | - Joyce Wong
- Department of Cardiology, Harefield Hospital and Royal Brompton Hospital, London UB96JH, UK;
| | - Eleftherios Tsiamis
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
| | - Costas Tsioufis
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
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50
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Nanda S, Gyftopoulos A, Hardy N, Burke AP, Chow RT. A Cardiac Amyloidosis Presentation: Atrial Mass Versus Thrombus. Cureus 2020; 12:e11944. [PMID: 33425523 PMCID: PMC7785482 DOI: 10.7759/cureus.11944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cardiac neoplasms are a rare finding of which a cardiac myxoma is the most commonly encountered. Therefore, a density identified in the left atrium commonly leads to the presumptive diagnosis of an atrial myxoma. However, other pathologies, such as atrial thrombi, can mimic in clinical presentation and appearance to a myxoma. Clinically, these pathologies may lead to obstructive symptoms such as syncope, palpitations, or sudden cardiac death. At present, echocardiography, magnetic resonance imaging, or computed tomography can be used to identify such masses, but fall short of identifying the primary cause. The management of atrial thrombi is not yet fully understood and definite recommendations have not been established. We present a case of an 87-year-old man complaining of syncopal episodes found to be secondary to an incidental intracardiac density resulting from age-related amyloidosis.
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Affiliation(s)
- Saheba Nanda
- College of Medicine, American University of Antigua, Coolidge, ATG
| | - Alex Gyftopoulos
- Department of Medicine, University of Maryland Medical Center, Baltimore, USA
| | - Naomi Hardy
- Department of Pathology, University of Maryland Medical Center, Baltimore, USA
| | - Allen P Burke
- Department of Pathology, University of Maryland Medical Center, Baltimore, USA
| | - Robert Td Chow
- Department of Medicine, University of Maryland Medical Center, Baltimore, USA
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