Surgical treatment of cardiac neoplasms: 32-year experience

In the last 25 years, there have been extraordinary advances and new developments in diagnosis and surgical treatment for cardiac tumors. New diagnostic methods have almost replaced the need for cardiac catheterization and ventriculography. During cardiopulmonary bypass the myocardium can be protected by means of hypothermia and cardioplegia. Various techniques have been developed to excise cardiac tumors. Depending upon the site and the extent of the neoplasm, additional cardiac repair may be required, including bypass grafting or valve replacement. Primary tumors of the heart are usually intracavitary lesions and more than 75% are benign. Myxomas are the most common cardiac tumors. They are usually attached to the intraatrial septum in the left atrium close to the fossa ovalis. Left atrial myxomas must be distinguished from mitral valve disease, since the clinical presentation may suggest rheumatic feaver and acute myocarditis. Since 1957 we have operated upon 71 patients with myxomas with no deaths. Removal of a myxoma should be undertaken more aggressively and thoroughly than formerly was recommended. Rhabdomyomas are usually multiple tumors, and most often they involve the ventricular myocardium. Because these tumors do not grow rapidly, surgical resection can be successful. It the tumor is large, it can be partially resected to release the obstruction. We have operated upon 3 patients with this tumor. Cardiac fibromas are the second most common tumor in infants and children. These are usually solitary tumors which compress the surrounding structures as they grow. Complete excision of fibromas is difficult since the tumors tend to grow large. We have operated upon 11 patients with this tumor.(ABSTRACT TRUNCATED AT 250 WORDS)