[Cardiac tumor, constrictive pericarditis and pulmonary thromboembolism]

Cardiac tumors are rare, and 3-quarters of these tumors are benign and nearly half of the benign tumors are myxomas. Metastases to the heart are more common than primary cardiac tumors. Cardiac tumors present obstructive, constitutional and embolic signs and symptoms. Echocardiograms, chest computed tomography (CT) and magnetic resonance imaging (MRI) scan are very useful for diagnosis. Surgery is indicated in patients with benign tumor, and chemo/radio-therapy in patients with malignant tumors. Prognosis after surgery is good, instead poor prognosis for patients with malignancy. Constrictive pericarditis is mainly result of idiopathic, previous cardiac surgery and radiation in recent years. Diagnosis is made by echo cardiography and cardiac catheterization along with clinical presentation. Thickened pericardium is directly diagnosed by currently advanced transesophageal echocardiography, CT and MRI although normal thickness of the pericardium with constrictive pericarditis is observed in some patients. Pericardiectomy is the only treatment for permanent constriction. The incidence of pulmonary thromboembolism is currently increasing in Japan. Guidelines for the diagnosis, treatment and prevention of pulmonary thromboembolism and deep vein thrombosis (JCS 2009) is helpful for diagnosis and treatment decision. Anticoagulant is initial treatment for acute pulmonary thromboembolism, and intravenous thrombolysis is performed in hemodynamically unstable cases. Chronic thromboembolic pulmonary hypertention is treated by pulmonary endarterectomy whereas anticoagulant and vasodilator are used for peripheral type and mild cases.