Tumours of the heart valves

Tumours involving cardiac valves pose complex diagnostic and therapeutic challenges. In this review, we use three theoretical cases as a foundation to explore diagnostic workup, therapeutic interventions, and follow-up for both benign and malignant tumours of the heart valves.

While the differential for valvular masses is broad, the most common valvular tumours are benign. Multimodal imaging, usually beginning with echocardiography, and tissue sampling where feasible, are the core tenants of diagnostic workup. Highly mobile lesions on a stalk that are isolated to the valve are likely to be papillary fibroelastomas. However, malignancy should be considered in cases of immobile lesions with unclear boundaries. Based on available data, left sided benign tumours involving valves should be excised promptly given the safety and efficacy of operative approaches and the risk of embolization. For suspected malignancy, biopsy should be organized and a centre of excellence should be consulted. Given that recurrence is possible for benign lesions, and is effectively certain for malignant lesions, a lifelong follow-up plan is crucial.

Current treatment paradigms for valvular tumours described herein are based entirely from anecdotal and retrospective data. Future standardization and optimization of treatment protocols depend on the systematic gathering of long-term prospective data.