Search

Cardiac tumors are rare; however, they pose diagnostic and therapeutic challenges on the physician and, in most cases, interdisciplinary approaches are necessary. The present article summarizes the most frequent cardiac tumors and discusses the diagnostic aspects and therapeutic consequences. The focus of this article is on primary cardiac tumors.

Background and Purpose: Advances in the development of video-assisted systems for minimally invasive surgery now allow to perform cardiac surgery via a smaller anterolateral thoracotomy in order to reduce trauma, pain and improve cosmetics. In addition, due to sternal sparing, pulmonary function should improve resulting in reduced hospital stay and costs. However, only few centers worldwide abstain from spreading the ribs thus accepting considerable pain and reduced patient comfort. The minimally invasive approach described here uses a right-sided anterolateral incision (4-5 cm), a soft-tissue retractor and femorofemoral perfusion with endoclamping under continuous TEE (transesophageal echocardiography) control. It was the aim of this retrospective analysis to determine feasibility, safety and effectiveness of the method., Patients and Methods: At the West German Heart Center Essen, 47 patients were operated using minimally invasive endoscopic techniques between January 2004 and April 2006 on the mitral valve (n = 31), mitral and tricuspid valve (n = 9), including mini-Maze procedure in two cases, as well as atrial septal defects (n = 5) and myxomas (n = 2). Mean age was 58 +/- 15.2 years (range 29-87 years), NYHA II-III, 20 patients were male., Results: All but one patient survived (2.1%). Conversion to median sternotomy was necessary in three of the first twelve patients. After a mean follow-up period of 18 months all reconstructions and valves were competent, freedom from cardiac reoperation was 100%. On a visual analog scale 91% ot the patients reported no or mild postoperative pain, 96% felt they had an aesthetically pleasing scar. All but one patients would choose the same operation again., Conclusion: Videoscopically assisted, endoscopic cardiac surgery can be performed safely, but requires a learning curve and intense training. After evaluation of efficacy and safety it is now the authors' exclusive approach to isolated atrioventricular valve disease with an ideal pain-free and cosmetic result.

Benign intracavitary cardiac tumors lead to "malignant" complications, so early diagnosis and adequate treatment are of vital importance. Our investigation summarizes a 10-year experience after surgical treatment of 29 patients suffering from benign intracavitary cardiac tumors. The postoperative histological examination revealed a myxoma in 27 cases; in 2 cases a papillary fibroelastoma was diagnosed. The main symptom in 19 patients was dyspnea. In 8 cases an embolic event occurred. All patients underwent extirpation of the tumor. Early mortality was 10%, while late mortality was 4%. The treatment of choice of benign intracavitary cardiac tumors is extirpation, which, due to unpredictable embolic complications, is to be carried out immediately should the tumor have a lobulated tuberous surface. In such cases the descriptive function of echocardiography is of considerable importance.

Malignant pericardial effusion (MPE) presents as a clinical spectrum that ranges from totally asymptomatic to acute cardiac tamponade. Primary malignancies with a propensity for cardiac involvement include lung cancer, breast cancer, and lymphomas. Echocardiography is one of the most specific and sensitive non-invasive tests in the evaluation of MPE. Pericardiocentesis is both a diagnostic and therapeutic tool in the management of MPE. Several non-specific sclerosing agents are available for instillation into the pericardium to prevent a recurrence of pericardial effusion. Mechanical interventions including different surgical approaches are also highly effective. Ultimately, therapy of MPE must be individualized according to the patient's clinical condition and underlying malignancy. The main goal of therapy is to achieve lasting relief from effusion recurrence as quickly and as safely as possible.