Primary Cardiac Tumors

Introduction: Primary cardiac tumors (PCT) are rare with autopsy prevalence of 0.02%. 75% of them are benign. Atrial myxomas are the most common (50% of all PCT) followed by Papillary fibroelastomas (10% of all PCT). 25% of PCT are malignant, most of them are Sarcomas.

Objective: This study describes the epidemiology and pathology of PCT in Soroka medical center, details the perioperative clinical characteristic, echocardiographic finding, surgical treatment and midterm outcomes.

Patients and Methods: From Jan 2008 to December 2018, 23 patients underwent cardiac surgery for PCTs. Preoperative clinical diagnosis was made by echocardiography (TTE, TEE) and was confirm by histopathologic examination. 14 (61%) were females, mean age 61±11, average. The clinical presentations were neurological (TIA/CVA) 48%, chest pain (13%), acute MI(13%), dyspnea (13%) other symptoms (8.7%) and in one case it was un incidental finding.

Results: 9 PCT were diagnosed as cardiac myxomas all were in the left atrium (average size – 19.7mm), in 2 cases the lesion involved the mitral valve , concomitant CABG was necessary in 2 cases. 11 PCT were papillary fibroelastomas of them 7 were on the aortic valve ,3 on the mitral valve chords and one on tricuspid valve. Two PCTs were malignant sarcomas one in the left atrium and the other attached to the pulmonic valve .One PCT was diagnosed as accessory mitral valve.

There were no perioperative mortality or thromboembolic events. Two patients died 9 months and 36 months postop due to abdominal sepsis and sarcoma recurrence respectively. Outpatient cardiac echocardiograms, obtained 14±13 months (2-40months), revealed no tumor recurrence in the benign cases.

Conclusions: Primary cardiac tumors are rare, most of them benign. The presenting symptom can be variable, the diagnosis is made by echocardiography and surgical resection is the primary treatment with good outcomes and no recurrence in the benign cases.