Cardiac tumors: the experience of a tertiary cardiology center

Cardiac tumors represent a rare condition, often presenting with severe symptoms and having a poor outcome in the absence of early diagnosis and therapy. The aim of this study was to assess the prevalence and type of cardiac tumors, the techniques used for the diagnosis and the therapy used in a tertiary cardiology center.

During a 2-years period, among the 35004 patients (pts) hospitalized in our Cardiology Department, 24 pts were diagnosed with CTum (0.068% of all hospitalizations). A retrospective study of CTum cases was based on the patient files, with full clinical data, paraclinic investigations and therapy details.

In the CTum group (49 +/- 16.2 years, similar between men and women), the main symptoms leading to patients referral were dyspnea (15 pts, 62.5%) and embolic events (coronary, cerebral, peripheral arteries: 7 pts, 29%), while in 4 asymptomatic pts the diagnosis was incidental. Transthoracic echocardiography (TTE) detected the presence of CTum in all cases. In 20 pts (83%), TTE and transesophageal echocardiography (TEE) provided all the data required for preoperative assessment (tumor size, extension, location, insertion site). In 4 pts, additional CT and MRI investigations were necessary, mainly for complex disease (malignant secondary CTum). The imaging techniques suggested a diagnosis of benign tumor in 15 pts (62.5%) and malignant tumor in 5 pts. In 4 pts the tumor type could not be established. Myxoma was the most frequent diagnosis (14 pts, 58% CTum). Among malignant CTum, secondary tumors (melanoma, lung and uterine cancer) were more frequent than primary CTum (4 vs 1 pt). The localization of CTum was intracavitary in 22 pts, 91% mainly in the left atrium (15 pts), intramyocardic in 1 pt and pericardic in 1 pt. Surgery was performed in 18 pts, confirming the preoperative diagnosis in 17 cases (94%). In one case, a myxochondrosarcoma was diagnosed at pathology in a patient with an echocardiography-based preoperative diagnosis of myxoma.

CTum represent a rare condition, accounting for only 0.068% of hospitalizations in a tertiary cardiology center, but with severe clinical presentation. Echocardiography (TTE and TEE) is the essential imaging modality, allowing in most cases the diagnosis, classification and localization of CTum and their insertion site. CT and MRI are useful additional modalities in complex cases (mainly malignant primary and secondary CTum). In the case of benign tumors, surgery must be performed as soon as possible after the diagnosis has been established, whereas for malignant tumors there is still much controversy in what regards the benefits of surgery.