Cardiac Tumors

Myxomas are the most common benign tumors of the heart. They are usually globular in shape and have a soft, gelatinous consistency. They have a predilection for the left atrium where they are attached to the limbus of the fossa ovalis.

Myxomas occur in patients of all age groups but are most frequent in middle-aged women. Seventy-five percent of myxomas originate in the left atrium, 18% in the right atrium and the remainder in the ventricles.

Patients present either with signs and symptoms of hemodynamic compromise, with systemic embolization, or rarely with constitutional symptoms. The hemodynamic symptoms are usually due to obstruction of flow across the atrioventricular valves. Patients with left atrial myxomas often present with dyspnea, orthopnea, and paroxysmal nocturnal dyspnea, with or without hemoptysis, as in mitral stenosis. This obstruction of flow is charactistically progressive but could be intermittent. Myxomas may cause atrioventricular valve insufficiency by preventing valve closure or by damaging the valve leaflets.

Systemic embolization is a major complication of left atrial myxomas and this is the presentation of almost 50% of the patients. Emboli have been reported in every organ including the coronary arteries. About 50% of emboli involve the central nervous system resulting in various neurological deficits. Peripheral arterial emboli result in pain and coldness of an extremity. Coronary artery embolization causes angina. Pulmonary embolism from right-sided myxomas is surprisingly low.

The constitutional symptoms from myxomas include fever, malaise, weight loss, clubbing of the fingers and toes, fatigue, myalgias and arthralgias. These constitutional symptoms are not infrequently the only manifestations of cardiac myxomas.

Two-dimensional echocardiography is now the most appropriate screening and diagnostic imaging modality for cardiac myxomas (Fig. 8.1). This method can identify the precise origin of the myxoma and it may demonstrate the tumor prolapse through the atrioventricular valve (Fig. 8.2a-b). It also can exclude any valvular heart disease.

Surgical excision is the treatment of choice of cardiac myxomas and this should proceed on an urgent basis. This excision is done under direct vision using car-diopulmonary bypass and hypothermic cardioplegic arrest. Tumor manipulation should be minimal during cannulation to prevent tumor dislodgement and embolization. The operative mortality is less than 5%, and the prognosis after surgical excision is usually excellent.

Although the most common benign primary cardiac tumor by far is the myxoma, other benign tumors include rhabdomyoma, fibroma, lipoma, teratoma, hemangioma, and pheochromocytoma. The papillary fibroelastoma is a small, benign neoplasm usually on the midportion of the aortic or mitral valves, but may occur on the papillary muscles, chordae, or elsewhere.

Cardiac malignancies are primary or metastatic, and while both are very rare, the latter are exceedingly more common. Of the infrequent primary cardiac ma-

Fig. 8.1. A transesophageal echocardiogram (TEE) showing a left atrial myxoma attached to the atrial septum. Courtesy of Leonard Ginzton, Harbor-UCLA, UCLA School of Medicine.

Fig. 8.2. A TEE showing left atrial myxoma in systole (a) and diastole (b). Note prolapsing of this myxoma through the mitral valve in diastole. Courtesy of Leonard Ginzton, Harbor-UCLA, UCLA School of Medi-

Fig. 8.2. A TEE showing left atrial myxoma in systole (a) and diastole (b). Note prolapsing of this myxoma through the mitral valve in diastole. Courtesy of Leonard Ginzton, Harbor-UCLA, UCLA School of Medi-

Malignant Neurogenic Tumors
Your Heart and Nutrition

Your Heart and Nutrition

Prevention is better than a cure. Learn how to cherish your heart by taking the necessary means to keep it pumping healthily and steadily through your life.

Get My Free Ebook


Post a comment