Medicine › Cardiology and Cardiovascular Medicine

Cardiac tumors and thrombi

Works Count: 42625

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Description

This cluster of papers focuses on the diagnosis, management, and molecular features of cardiac tumors, including primary cardiac neoplasms, left ventricular thrombus, and pulmonary artery sarcoma. It also explores the genetic mutations associated with conditions like the Carney complex and PRKAR1A gene mutations. The papers discuss imaging techniques such as echocardiography and MRI for evaluating cardiac masses and tumors.

Keywords

Cardiac Tumors; PRKAR1A Gene Mutations; Left Ventricular Thrombus; Cardiac Imaging; Primary Cardiac Neoplasms; Carney Complex; Pulmonary Artery Sarcoma; Echocardiography; Metastatic Cardiac Involvement; Cardiac Myxomas

Diagnosis of noninfective cardiac mass lesions by two-dimensional echocardiography. Comparison of the transthoracic and transesophageal approaches.

1991-01-01

Andreas Mügge , Werner G. Daniel , Axel Haverich +1 more

This study was conducted in 46 patients with cardiac thrombi, 15 patients with atrial myxomas, and 32 patients with other cardiac or paracardiac tumors. Diagnoses were subsequently proven by surgery, … This study was conducted in 46 patients with cardiac thrombi, 15 patients with atrial myxomas, and 32 patients with other cardiac or paracardiac tumors. Diagnoses were subsequently proven by surgery, autopsy, computed tomography, magnetic resonance imaging, or angiography in all patients. All patients underwent precordial and transesophageal two-dimensional echocardiography to assess the various mass detection rates. Atrial myxomas and predominantly left-sided cardiac tumors were identified by both echocardiographic techniques with comparable detection rates. Left ventricular apical thrombi were detected more frequently by precordial echocardiography. In contrast, transesophageal echocardiography was superior in visualizing left atrial appendage thrombi, small and flat thrombi in the left atrial cavity, thrombi and tumors in the superior vena cava, and masses attached to the right heart and the descending thoracic aorta. These data indicate that transesophageal echocardiography leads to a clinically relevant improvement of the diagnostic potential in patients in whom cardiac masses are suspected or have to be excluded in order to ensure the safety of clinical procedures.

Complications of angiography.

1981-02-01

SJ Hessel , DF Adams , Abrams Hl

This study was designed to assess the complications of angiography, including transfemoral, transaxillary, and translumbar approaches. Detailed questionnaires were completed by radiologists at 514 of the 2,066 hospitals surveyed. The … This study was designed to assess the complications of angiography, including transfemoral, transaxillary, and translumbar approaches. Detailed questionnaires were completed by radiologists at 514 of the 2,066 hospitals surveyed. The radiologists reported on the complications of 118,591 examinations. The overall arteriography complication rates were: transfemoral 1.73%, translumbar 2.89%, and transaxillary 3.29%. Thirty deaths were reported, eight of which were caused by aortic dissection or aneurysm rupture. Among the three techniques, there was no difference in the incidence of cardiac complications. There were significantly more neurologic complications, including seizures, in the transaxillary group than there were in either the transfemoral or translumbar groups. Similarly, hemorrhage, arterial obstruction, and pseudoaneurysms were more common with the transaxillary technique than with either of the other approaches. Vessel perforation and extraluminal contrast material were seen most frequently with the translumbar technique. Overall, between the two selective approaches, the transfemoral route carried a significantly smaller risk of complications than the transaxillary approach. There was an inverse relationship between complication rate and the annual number of arteriograms obtained. This was most striking in hospitals without residency training programs. The complications of adrenal venography, peripheral venography, pedal lymphography, and of studies for suspected pheochromocytoma were also assessed.

Transesophageal two-dimensional echocardiography for the detection of left atrial appendage thrombus

1986-01-01

W. Aschenberg , Michael Schlüter , P. Kremer +3 more

Primary sarcomas of the heart

1992-01-15

Allen Burke , David N. Cowan , Renu Virmani

Seventy-five primary sarcomas of the heart were classified by histologic appearance as angiosarcoma (26 cases), undifferentiated sarcoma (18 cases), osteosarcoma (9 cases), fibrosarcoma (6 cases), malignant fibrous histiocytoma (6 cases), … Seventy-five primary sarcomas of the heart were classified by histologic appearance as angiosarcoma (26 cases), undifferentiated sarcoma (18 cases), osteosarcoma (9 cases), fibrosarcoma (6 cases), malignant fibrous histiocytoma (6 cases), leiomyosarcoma (4 cases), myxosarcoma (3 cases), synovial sarcoma (2 cases), and neurofi-brosarcoma (1 case). The ages of the patients ranged from 1 to 75 years at the time of presentation (mean, 39 years). Angiosarcomas were predominantly right-sided and osteosarcomas left-sided. Forty patients treated surgically were examined, and survival correlated with clinical and histologic parameters. The survival rate was poor, with a mean of 11 months and median of 6 months. By univariate analysis, the survival rate was more favorable for patients with tumors located on the left side of the heart, without necrosis, with a low mitotic count, and without metastasis at diagnosis. Survival rates were better in patients receiving chemotherapy and radiation therapy. Age, gender, presence of differentiation, and histologic type did not affect prognosis. By multivariate analysis, a low level of mitotic activity and any therapy were the only significant factors affecting survival rate. Immunostaining with commercially available antisera was useful in the diagnosis of sarcoma but not in subclassification of 19 tumors so tested. Although the prognosis for patients with cardiac sarcomas is dismal, histologic grading is useful in predicting outcome, as has been shown for soft tissue sarcomas of other sites.

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Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases

2003-09-01

Ramesh M. Gowda , Ijaz A. Khan , Chandra K. Nair +3 more

The Complex of Myxomas, Spotty Pigmentation, and Endocrine Overactivity

1985-07-01

J. Aidan Carney , Hymie Gordon , Paul C. Carpenter +2 more

CARNEY, J. AIDAN M.D., PH.D., F.R.C.P.I.; GORDON, HYMIE M.D., F.R.C.P.; CARPENTER, PAUL C. M.D.; SHENOY, B. VITTAL M.D.; W. GO, VAY LIANG M.D. Author Information CARNEY, J. AIDAN M.D., PH.D., F.R.C.P.I.; GORDON, HYMIE M.D., F.R.C.P.; CARPENTER, PAUL C. M.D.; SHENOY, B. VITTAL M.D.; W. GO, VAY LIANG M.D. Author Information

Accuracy of Transesophageal Echocardiography for Identifying Left Atrial Thrombi: A Prospective, Intraoperative Study

1995-12-01

Warren J. Manning

Objective: To determine the ability of transesophageal echocardiography to accurately identify or exclude left atrial thrombi. Design: Prospective cohort study. Setting: University hospital. Patients: 231 consecutive patients having transesophageal echocardiography … Objective: To determine the ability of transesophageal echocardiography to accurately identify or exclude left atrial thrombi. Design: Prospective cohort study. Setting: University hospital. Patients: 231 consecutive patients having transesophageal echocardiography before elective repair or replacement of the mitral valve or excision of a left atrial tumor. Fifty-six percent of patients had a history of atrial fibrillation, and 17% had a history of thromboembolism. Measurement: Identification of left atrial thrombi during transesophageal echocardiographic examination and comparison with direct near-simultaneous visualization during cardiac surgery. Results: Transesophageal echocardiography identified 14 left atrial thrombi in 14 patients (6%). Thrombus size ranged from 3 to 80 mm. Surgery confirmed 12 of 14 thrombi (86%), including 9 thrombi confined to the left appendage. No additional thrombi were found on direct inspection of the atria (sensitivity, 100% [95% CI, 74% to 100%]; specificity, 99% [CI, 97% to 99.9%]; positive predictive value, 86% [12/14]; negative predictive value, 100% [217/217]; for a population that had a 5.2% prevalence of thrombi). All 12 surgically confirmed thrombi were identified by two independent observers. Neither thrombus seen by only a single observer on transesophageal echocardiography was confirmed during direct inspection of the atria at surgery. Conclusion: Transesophageal echocardiography is highly accurate for identifying left atrial thrombi and can be used clinically to exclude left atrial thrombi.

Clinical Presentation of Left Atrial Cardiac Myxoma

2001-05-01

L. Pinède , P. Duhaut , R Loire

Introduction Cardiac myxoma is the most frequent "benign" tumor of the heart and presents an important diagnostic challenge (4,43,47). Myxomas may resemble many cardiovascular or systemic diseases, and can arise … Introduction Cardiac myxoma is the most frequent "benign" tumor of the heart and presents an important diagnostic challenge (4,43,47). Myxomas may resemble many cardiovascular or systemic diseases, and can arise in any of the cardiac chambers, although 75% occur in the left atrium. Most cases of atrial myxomas are now diagnosed in living patients, allowing successful surgical extirpation (1,3,30,44,53). Before the introduction of angiocardiography in 1951, cardiac myxoma diagnosis was made only at autopsy (22). The first successful surgical removal of an atrial myxoma was performed in 1954 (35,47). In 1959, the first M-mode echocardiogram of a left atrial myxoma was reported (16). Indeed, the introduction of echocardiography has provided an important noninvasive means of diagnosis for cardiac myxomas (55). Thus, the diagnosis of small myxomas (less than 5 cm in size and asymptomatic) is becoming easier. We report here the experience of a French cardiovascular center in the clinical presentation of left atrial myxomas. The large number of patients in this series allowed us to perform an analytic, clinicopathologic study. Patients and Methods We reviewed the 112 cases of left atrial myxoma seen at 1 institution (Hôpital Louis Pradel, Lyons, France) over a 40-year period (1959–1998). In all cases the diagnosis was established before surgical removal. The patients' medical records were reviewed, and data concerning clinical presentation, diagnostic methods, and postoperative course were collected. Histopathologic slides were reviewed for all cases by the same pathologist (RL). Other locations where cardiac myxoma occurred during that time period were the right atrium (15 cases), left ventricle (2 cases), and right ventricle (1 case). Follow-up information was obtained by contacting either the patients or the attending physicians, and a standardized questionnaire was completed for each case. Statistical analysis A chi-square test, or the Fisher exact test when required, was performed for all qualitative variables, and odds ratios (OR) with 95% confidence intervals (95% CI) were computed. For ordinal variables a Wilcoxon rank sum test was used. Data analysis was performed using SAS (Statistical Analysis System, SAS Institute Inc., Cary, NC). The variables studied in the statistical analysis were 1) sex and age, period of diagnosis (before or after echocardiography was available), delay to diagnosis (delay between the first symptoms and diagnosis), possible systematic (serendipitous) discovery; 2) size of the tumor (> or < 5 cm), tumor surface appearance (smooth or villous); 3) the main symptoms: cardiac (cardiac failure, malaise or syncope, chest pain or palpitations), embolic (cerebral, coronary, or peripheral artery), systemic (fever, weight loss, or pseudo-connective tissue disease signs), or neurologic (stroke, vertigo, epilepsy, coma, or other signs); 4) cardiac auscultation modifications (pseudo-mitral signs, "tumor plop", nonspecific other signs); 5) possible chest X-ray abnormalities (left cardiac failure signs, cardiomegaly, pleural effusion, left atrium enlargement, visible myxoma when calcified), electrocardiogram (ECG) alterations (arrhythmias or conduction disturbances, ST-segment and T-wave shifts, left atrial hypertrophy, and nonspecific signs), or serologic test abnormalities (elevated erythrocyte sedimentation rate [ESR], anemia). Results Patient characteristics The study group included 72 women, (64% of the whole sample; median age, 53 yr; range, 23–84 yr) and 40 men (36% of the sample; median age, 58 yr, range, 5–77 yr). Forty-six patients (41% of the sample, 31 women, 15 men) were less than 50 years old, 47 (42%, 31 women, 16 men) were between 50 and 70 years, and 19 (17%, 10 women, 9 men) were older than 70. Age distribution was homogenous in men, but most female patients were between 40 and 60 years old (Figure 1).Fig. 1: Age distribution of 112 patients with left atrial myxoma.The clinical and laboratory features of left atrial myxoma in our series are presented in Table 1. The different frequencies of clinical and laboratory signs according to sex and age are detailed in Table 2. Male patients were more at risk than females for embolic complications and for neurologic symptoms; females were more at risk than males to develop systemic symptoms such as fever; younger patients (age <50 yr) had more neurologic symptoms and cardiac auscultation abnormalities than older patients (age >50 yr).TABLE 1: Clinical and laboratory features of left atrial myxoma (112 cases)TABLE 2: Frequencies of clinical and laboratory signs by sex and age*We divided the patients into 2 groups according to the pre-and post-echocardiography periods: 1) between 1959 and 1977, when the only diagnostic methods were angiocardiography and cardiac cathe-terization, only 14 patients (12.5%) underwent surgery; 2) since 1977, with 2-dimensional echocardiography use (transthoracic, then transesophageal), about 5 patients per year have undergone surgery for left atrial myxoma (98 patients, 87.5%). The sex ratio and age ranges are similar in these 2 patient groups, but other differences can be identified (Table 3). Before 1977, most patients were diagnosed on the basis of serologic or blood test abnormalities (particularly elevated ESR) and radiologic abnormalities; chest X-ray evidence of cardiac failure or left atrium enlargement was particularly prevalent in patients diagnosed before 1977 compared with those diagnosed after 1977 (p = 0.006 and p = 0.02, respectively).TABLE 3: Symptoms by year of diagnosis*Delay before surgery In our series, the time interval between symptoms onset and diagnosis (surgical removal) varied from 0 to 126 months (median, 4 mo). The median delay before surgery was 5.5 months before 1977, and 3 months after 1977; the difference is not significant. The median delay to diagnosis increased significantly when cardiac symptoms were present; there was no significant difference for the other symptoms (Table 4).TABLE 4: Delay to diagnosis by year and by principal clinical symptoms*Initial symptoms ( Figure 2) For 11 patients, the left atrial myxoma diagnosis was a mere chance, or serendipitous, discovery ("systematic findings" in Figure 2). Among these patients, in 9 cases echocardiography (8 cases) or computed tomography (CT) (1 case) was performed for another indication and allowed a diagnosis of myxoma. For 2 patients, echocardiography had been systematically performed during follow-up for surgery on a right atrial myxoma.Fig. 2: Initial symptoms of left atrial myxoma (112 cases).The most common initial symptoms of left atrial myxoma in our series were related to mitral valve obstruction: dizziness and occasionally syncope, palpitations, dyspnea, cough, pulmonary edema, or congestive heart failure were observed in 58 patients. Eight patients showed atypical paroxysmal clinical manifestations: chest pain, hemoptysis, limb claudication, thoracic noise, shortness of breath, or syncope when reclining. Embolic manifestations suggested myxoma in 18 patients. Constitutional or general systemic signs appeared as initial manifestations for 17 patients: myalgia, muscle weakness, arthralgia, fever, weight loss, fatigue, and Raynaud syndrome. Clinical features at diagnosis All patients presented with at least 1 or more symptoms of the classic triad: 1) obstructive cardiac signs; 2) embolic signs; and 3) constitutional or systemic manifestations (See Table 1). 1) Intracardiac obstruction signs occurred in 75 patients. Pulmonary edema or progressive congestive cardiac failure (dyspnea, orthopnea) were the most common symptoms (n = 48). Malaise or syncope occurred in 16 cases. Two patients experienced cardiac arrest before surgery and fully recovered after resuscitation. Other nonspecific cardiac symptoms were present in 34 patients: cough, thoracic pain, palpi-tations, myocardial infarction due to coronary embolism. Malaise, palpitations, or thoracic pain could vary with body postural changes. 2) Signs of embolism were present in 33 patients, either with 1 (n = 25) or several (n = 8) locations. Embolic locations were the central nervous system (n = 24), in 1 case in the retinal artery, the upper and lower extremities (n = 15), and the coronary arteries (n = 4). 3) Thirty-eight patients presented with systemic or constitutional symptoms. These symptoms were obviously nonspecific, including fever (n = 22), weight loss or fatigue (n = 20), and immunologic diseases mimicking symptoms such as myalgia, muscle weakness, arthralgia, or Raynaud syndrome (n = 6). 4) Other clinical presentations 4.1) Twenty-nine patients had neurologic symptoms, particularly transient or permanent motor or sensory neurologic deficiencies (n = 23), when cerebral emboli were present (stroke). Three of these patients developed multiple cerebral aneurysms, induced by cerebral emboli. Three patients had epileptic fits, or multilocular sclerosis mimicking symptoms. Six patients also suffered from other neurologic manifestations, such as vertigo or coma. One patient with streptococcal meningitis underwent surgery for a supposed antibiotic-resistant endocarditis suggested by echocardiographic findings, but surgery uncovered an incidental noninfected myxoma. 4.2) One patient had fever and positive blood cultures for Streptococcus viridans. 4.3) Three patients were investigated for liver abnormalities connected in fact with right cardiac failure. 4.4) For 3 patients, the main symptoms were abdominal pain or hemoptysis. Physical examination (cardiac auscultation) On cardiac auscultation 72 patients (64%) had abnormal findings, 18 (16%) of them with postural changes or with time examination modifications. These murmurs looked like significant mitral stenosis findings: apical diastolic or presystolic murmur (n = 60, 53%). A tumor plop was heard in 17 patients (15%), all before 1989. Other auscultatory features were changes in preexisting murmurs, gallops, or modification of the first (split) or second heart sound (n = 12, 11%). A significant association was observed between cardiac auscultation abnormalities and 1) systemic symptoms (fever, weight loss or fatigue); and 2) cardiac symptoms and signs (cardiac failure, etc.) (Table 5). Conversely, no association between auscultatory signs and embolic or neurologic symptoms was significant.TABLE 5: Correlations between various clinical abnormalities*Laboratory tests The most frequent laboratory finding was ESR (Westergren method) >20 mm/hr, found in 36 patients (see Table 1). Anemia (hemoglobin <12 g/dL in men, <11 g/dL in women) was observed in 15 patients. Leukocytosis (white blood cell counts >10,000/mm3) or thrombocythemia (platelet counts >500,000/mm3) was present in 6 patients. The association between these serologic abnormalities and systemic manifestations was significant (see Table 5). However, there was no significant association between serologic signs and cardiac, embolic, or neurologic symptoms. Electrocardiogram abnormalities Two-thirds of the patients (n = 69) had abnormal electrocardiographic findings (see Table 1). Left atrial hypertrophy was the most frequent ECG sign (n = 39). Atrial arrhythmias (atrial fibrillation or flutter) or conduction disturbances were rare. Other electrocardiographic findings were ST-segment abnormalities (n = 24) or nonspecific ECG abnormalities (n = 27): ventricular hypertrophy, micro-voltage, extrasystoles. The association of ECG abnormalities with systemic manifestations and cardiac signs was significant (see Table 5). There was no significant association with embolic or neurologic symptoms. Chest X-rays Chest X-rays were abnormal in 56 patients (see Table 1). Nonspecific findings included pulmonary interstitial markings or congestive heart failure signs (n = 30), and nonspecific cardiomegaly (n = 35). Left atrial enlargement (n = 12), calcifications that made the tumor visible (n = 10), and pleural effusion were unusual (n = 8). The association of radiologic abnormalities with systemic and cardiac manifestations was significant (see Table 5). Chest X-ray abnormalities were significantly less frequent in patients with embolic or neurologic signs. Diagnostic methods Before 1977, all cases were diagnosed by angiocardiography with left heart catheterization (n = 14, 12.5%). After 1977, echocardiography was the usual diagnostic method (n = 96, 85.7%). Initially, only transthoracic M-mode echocardiography was available (Figure 3). Later, 2-dimensional imaging and particularly transesophageal echocardiography became the preferred methods in many cases. For 2 patients (1.8%), the diagnosis was established by CT or magnetic resonance imaging (MRI).Fig. 3: Transthoracic parasternal long-axis echocardiogram: A round myxoma is seen in the left atrium.Anatomic findings The pathologic diagnosis of myxoma was obtained after surgical tumor resection for all cases. On gross pathologic examination, the tumor diameter ranged from 1 cm to 15 cm. The precise size was available for 104 cases: it was greater than 5 cm in 62 myxomas, and smaller in 42 (in some cases tumors had been fragmented during surgery). The weight of the tumors ranged from 15 g to 180 g (mean, 37 g). In our series 85% of the myxomas were pedunculated with a short stalk (<1 cm), and 15% were sessile. Of the left atrial myxomas in our series, 80% arose around the septal fossa ovalis margin and 5% from the posterior left atrial wall, with only a few other locations: external wall (3%), superior wall (3%), infero-medial wall (3%), left auricle base (3%), posterior commissure (2%), and small mitral valve (1%). The myxoma surface was studied in 96 cases: it was friable or villous in 34% of these (n = 33) and smooth (Figure 4) in the other cases (n = 63, 66%). The less common villous or papillary (Figure 5) myxomas had a surface that consisted of multiple fine or very fine villous, gelatinous, and fragile extensions, with a tendency to fragment spontaneously (Figure 6).Fig. 4: Smooth-surface left atrial myxoma after formalin fixation.Fig. 5: Villous-surface left atrial myxoma..Fig. 6: Fine-surface villous fringe (magnification × 400).The histopathologic findings were based on the presence of characteristic myxoma cells embedded in an amorphous myxoid matrix, composed of an acid-mucopolysaccharide-rich stroma. The myxoma cells had a spindle or stellate shape, an ovoid nucleus, and a pink eosinophilic cytoplasm; they were scattered throughout the matrix. The surface of the tumor was covered by a single layer of flat endothelial-like cells. Calcification was observed in 9% of the cases. We differentiated histologic "active myxoma," with a dense myxoma cell population, from "inactive myxoma," with a sparse cell infiltrate and sometimes calcification or even ossification. Also, we distinguished different levels of histologic differentiation: 1) "normal differentiation" (Figure 7), with numerous rudimentary or well-formed vessels surrounded successively by cells then by condensed matrix; 2) "poor differentiation" (Figure 8), with many isolated, dispersed cells or lepidic cells gathered in short chains throughout the matrix. Sixty-four percent of the cases were "active" left atrial myxomas, half of them with poor and half with normal differentiation; 36% were "inactive" myxomas (two-thirds with poor differentiation). All recurrences were observed in patients with active myxoma and poor differentiation.Fig. 7: Left atrial myxoma with normal differentiation: Abundant extracellular matrix with myxoma cells grouping in rudimentary vascular formations.Fig. 8: Left atrial myxoma with poor differentiation: Dispersed or lepidic myxoma cells gathered in short chains.No significant association could be found between myxoma size (< or > 5 cm) and diagnosis circumstances (asymptomatic or symptomatic cases); villous surface; or presence of embolic, neurologic, systemic, or serologic symptoms or signs (Table 6). However, a myxoma size >5 cm was significantly associated with cardiac symptoms, auscultatory signs, and ECG and chest X-ray abnormalities. Diagnosis of larger myxomas paradoxically appeared to be more difficult, and the delay to diagnosis was shorter for small tumors than for large tumors (see Table 6).TABLE 6: Relationship of various clinical features to myxoma size (104 patients)*Villosity was associated significantly with neurologic symptoms, embolic complications, and cardiac auscultation abnormalities. However, there was no significant association between villosity and cardiac, systemic, serologic, ECG, or X-ray signs or symptoms; serendipitous discovery; or delay in diagnosis (Table 7).TABLE 7: Relationship of various clinical features to myxoma surface (96 patients)*Postoperative course All patients had surgery. Four patients (3.5%) died during the perioperative period: 1 patient died in 1967 during a second surgical intervention for a recurrence of myxoma 6 years after the first surgical removal; a 66-year-old woman, operated on in 1965 with severe cardiac insufficiency and instable hemodynamic function, died on the second postoperative day from acute renal insufficiency; a 5-year-old boy died in 1978 from acute mitral insufficiency by a mitral annulus rupture; and a 73-year-old man died in 1996 from bacterial meningitis concomitant with the myxoma, whereas the incidental tumor had been removed successfully. Only 1 patient needed a prosthetic mitral valve replacement: bacterial endocarditis was associated with the myxoma. The most frequent postoperative complication was transient arrhythmias (supraventricular arrhythmia or atrial fibrillation) in 29 patients (26%). A permanent cardiac pacemaker implantation for persistent bradycardia was necessary for only 2 patients. Follow-up During the postoperative course, 13 patients (11.5%) were lost to follow-up: foreign patients who returned alive to their native country and did not answer our questionnaire. Among the other 99 patients, 4 died and 95 (96%) were alive during the follow-up period. Patients who presented with peripheral arterial embolization fully recovered. The longest follow-up for patients alive with multiple cerebral aneurysms is 14 years (a woman suffering a stable cerebellum syndrome). In the present series, survivors were followed for a median of 3 years (range, 1 mo-17 yr). Recurrence Six patients (5%) had a recurrence of myxoma. Three patients with sporadic myxoma relapsed in the left atrium, (2.5, 8, and 17 years later, respectively). Three other patients had Carney complex. One of them suffered 2 recurrences in the left atrium, 16 and 26 months later, respectively. The other 2 patients with Carney complex had an initial myxoma in the right atrium; for 1 of them the recurrence was localized in the left atrium 3 years later, and for the other the recurrences were multiple in the left atrium (0.5 and 3.5 years later, respectively) and then in the right atrium 6.5 years later. Discussion We report here the largest series of patients with left atrial myxoma consecutively diagnosed in a single institution, to our knowledge. The patients presented over a 40-year period. Our 2:1 female-to-male ratio is consistent with other studies, in which this ratio varies from 2:1 to 3:1 (35,47,55). Myxomas can occur in all age-groups but are most frequent between the third and sixth decades of life (13,30,44,47). They occur predominantly in adult women (70%), although currently there is no explanation for this female predominance (perhaps due in part to hormonal influence). In our series, younger age is significantly associated with neurologic signs or cardiac auscultation abnormalities, and gender is associated with neurologic or embolic symptoms in men and systemic symptoms in women. Clinical features The clinical features of these tumors are determined by their location, size, and mobility; there are no pathognomonic signs and symptoms that suggest the presence of a myxoma (35,47,55). In a minority of cases, there are no symptoms at all (47) (10% in our series). However, there is no significant association between the size of the tumor (< or > 5 cm) and the circumstances of discovery (symptomatic or asymptomatic). Left atrial myxomas become symptomatic when they obstruct the mitral valve, embolize peripherally, or cause systemic effects: 1) Obstructive symptoms (valvular ball-valve obstruction) occur in 54%–95% of patients (35,55), 67% in our series. Many cases masquerade as mitral valve disease, but, conversely in mitral stenosis, atrial fibrillation and history of rheumatic fever are uncommon (47); only 9% of patients had arrhythmias in our study. Cardiac obstruction can be revealed by unusual, rapidly progressive congestive cardiac failure (dyspnea on exertion or orthopnea), or by malaise, syncope, or sudden death (due to complete mitral valve obstruction by the myxoma or coronary arteries embolism). The extent of valvular obstruction may vary with body position, and these symptoms' postural changes are particularly suggestive of myxoma (35,47). Cardiac failure remains the most frequent manifestation (43% in our series). In our study, the presence of cardiac signs paradoxically increased the diagnosis delay, probably because one tends to believe that clinical symptoms are explained by another more common disease (myocardiopathy due to hypertension, ischemic processes, etc.). 2) Systemic emboli are the second arm of the classic triad, occurring in 10%–45% of myxoma patients (4,35,55), 29% in our study. More than two-thirds of myxomatous emboli migrate to the central nervous system (28,50) (24/33 in our series), but any arterial bed may be affected, leading to a great variety of symptoms and signs. Recorded cases document emboli in the upper and lower extremities, aortic saddle, coronary arteries, kidneys, liver, spleen, eye, skin, and more (47). Cerebral emboli may lead to numerous fusiform aneurysms, described as typical of cardiac myxomas (48), as in 3 patients in our study, whose long-term outcome was good (follow-up: 14, 12, 8 yr, respectively). We demonstrate that the presence of an irregular or friable (villous) surface is significantly associated with cerebral and peripheral embolisms. 3) Constitutional signs are the third arm of the classic triad (8,47,55). While these symptoms are rarely prominent, they may occur in up to 90% of cases (35). The prevalence is lower in our series (34%), perhaps because we studied a population at a cardiovascular institute. These signs and symptoms include myalgia, muscle weakness, arthralgia, fever, weight loss, and fatigue. They are obviously nonspecific and may occur in a variety of infectious (endocarditis or rheumatic fever), malignant, or immunologic diseases (rheumatoid arthritis, vasculitis, connective tissue diseases). Nonspecific cutaneous manifestations have also been reported in myxoma patients (18,31). Cardiac auscultation Cardiac auscultatory findings may vary between examinations, and may depend on body position. Apical presystolic or diastolic murmurs, suggesting significant mitral stenosis, may be heard in more than half of the patients (47,55), 54% in our series. The specific auscultatory finding of myxoma is called "tumor plop": it is a protodiastolic heart sound of low frequency heard 0.08–0.15 seconds after the second heart sound (21,35). It may be confused with a third heart sound or a mitral opening snap. The tumor plop is uncommon, found in only 15% of patients in our series. We established a significant association between cardiac auscultation abnormalities and cardiac or systemic symptoms. Laboratory tests Serologic and hematologic tests are abnormal in only one-third of the patients (47,55), usually those presenting with systemic symptoms (a significant association was found in our study). The main but nonspecific laboratory abnormalities are anemia and elevated ESR, serum C-reactive protein, or globulin level. Anemia is generally normochromic or hypo-chromic; hemolytic anemia may occur by erythrocytes mechanical destruction on the tumor; polycythemia has also been reported. Less common findings are leukocytosis and thrombocythemia. Recent findings suggest that the production and release of a cytokine by the tumor itself may be responsible for systemic inflammatory and autoimmune manifestations (27). Interleukin-6 (IL6) has been implicated, with high serum levels of IL6 in patients with myxoma that return to normal after surgical removal (51). A correlation between the size of the tumor and the serum level of IL6 has also been suggested (54). Increased IL6 mRNA levels have also been found in myxoma tissue (52), probably explaining myxoma tissue infiltration in some cases by lymphocytes and plasma cells. Electrocardiogram findings ECG findings are nonspecific (35,47,55) but frequently observed (62% in our series). Left atrial hypertrophy occurs in one-third of patients, reflecting the hemodynamic alterations caused by the tumor. Atrial fibrillation is uncommon (less than 10% of cases) in contrast to the findings in mitral valve disease. We observed a significant association between ECG signs and the presence of cardiac or systemic symptoms. Chest X-rays Chest X-rays also reveal nonspecific features in half the patients (35,47,55) and are not helpful for diagnosis, except when the tumor is heavily calcified (9% in our study). Otherwise, a left atrium enlargement and signs of pulmonary congestion may be revealed. In our series, chest X-ray abnormalities were significantly associated with cardiac or systemic symptoms, but there were fewer radiologic signs when the myxoma was revealed by embolic or neurologic manifestations. In fact, cardiac signs or symptoms are more prevalent with large tumors, and one may hypothesize that friable, embolic tumors becoming symptomatic are diagnosed before the reach the size (about 5 cm) that leads to cardiac and radiologic signs. Our data suggest a positive association between small tumor size and embolic frequency (see Table 6). Diagnostic methods Echocardiography is the screening and diagnostic method of choice (36,47,55). It is accurate, reliable, noninvasive, and it does not entail any risk of tumor fragmentation and embolization (unlike angiography and cardiac catheterization). Transthoracic examination may be extended by the transesophageal approach (17,59). Transthoracic echocardiography is less invasive, with an excellent sensitivity, up to 95%(41,42), but transesophageal echocardiography sensitivity reaches 100%(17,39). Currently, the decision for surgery is generally based only on echocardiographic evidence of the disease; in our series angiocardiography has not been used since 1977. However, coronary arteriography in patients over 40 years old is usually required in order to rule out concomitant coronary artery disease (47). Other potential diagnostic methods include CT (40) and MRI (20,45). The advantage of CT and MRI over echocardiography is that they provide sectional views of mediastinal, pulmonary, and thoracic structures. They are also more accurate in assessing tumor attachment, endocardial site localization, and tumor stalk presence and size (45). Anatomic findings Anatomic data indicate that most left atrial myxomas arise from the atrial septum, usually near or around the fossa ovalis margin (14,19,55). Tumor mobility depends on the extent of attachment and on the stalk length. Gross appearance is generally white, gray-white, yellowish, or brownish with a polypoid, round or oval tumor, pedunculated or sessile. Tumor consistency is gelatinous (7), and the surface is either smooth or villous (66% and 34%, respectively, in our study). Smooth-surfaced myxomas usually appear with constitutional symptoms, while friable, irregular, or villous tumors usually embolize (30). In the literature (7,30), histologic findings such as fibrosis, calcification, and smooth surface are seen in older people, suggesting that they represent degenerative phenomena. In our series, there was no significant association between villosity and age. The size and weight of myxomas vary, but in our study, the mean duration of symptoms was paradoxically longer in patients with larger tumors. When, based on histologic appearance, we could distinguish active or inactive myxomas and normally or poorly differentiated myxomas according to the aspect of the cell infiltrate (33), we found that all recurrences actually occurred in patients with "active and poorly differentiated" myxomas. Many hypotheses regarding the origin of cardiac myxomas have been proposed (5,14,19). The current opinion of most authors is that myxomas are benign neoplasms of endocardial origin (24,32). It is no longer believed that myxomas are organized thrombi. Some myxomas may have a complex of pleomorphic cells that at first view may be considered malignant. However, the rare presence of multiple surface cell layers or mitotic activity is not associated with recurrence or any particular mode of presentation, and it is important not to predict an aggressive behavior on the basis of these atypical cells (7). Conversely, "myxoid imitators," which are true cardiac sarcomas, must not be confused with myxomas (2). The cells giving rise to the tumor are considered to be multipotential mesenchymal cells, and immunohistochemical analysis (5,7) has shown that myxoma cells express endothelial markers (60) as tumor vessel cells (QBEnd = CD34 and factor VIII-related antigen). Tumor cells are vimentin-positive, and some may be smooth-muscle-actin positive. Positivity for S-100 protein and cytokeratin (scarce cases with glandular structures) is rarely observed, as is the histocytic marker KP-1 (7,24). Burke (7) showed that endothelial differentiation was best demonstrated by CD34 positivity, which is also a sensitive endothelial marker for Kaposi sarcoma. This corroborates the concept that myxomas arise from primitive stromal cells having the capacity to

Clinical and Echocardiographic Characteristics of Papillary Fibroelastomas

2001-06-05

Jing Sun , Craig R. Asher , Xing Sheng Yang +7 more

Cardiac papillary fibroelastoma (CPF) is a primary cardiac neoplasm that is increasingly detected by echocardiography. The clinical manifestations of this entity are not well described.In a 16-year period, we identified … Cardiac papillary fibroelastoma (CPF) is a primary cardiac neoplasm that is increasingly detected by echocardiography. The clinical manifestations of this entity are not well described.In a 16-year period, we identified patients with CPF from our pathology and echocardiography databases. A total of 162 patients had pathologically confirmed CPF. Echocardiography was performed in 141 patients with 158 CPFs, and 48 patients had CPFs that were not visible by echocardiography (<0.2 cm), leaving an echocardiographic subgroup of 93 patients with 110 CPFs. An additional 45 patients with a presumed diagnosis of CPF were identified. The mean age of the patients was 60+/-16 years of age, and 46.1% were male. Echocardiographically, the mean size of the CPFs was 9+/-4.6 mm; 82.7% occurred on valves (aortic more than mitral), 43.6% were mobile, and 91.4% were single. During a follow-up period of 11+/-22 months, 23 of 26 patients with a prospective diagnosis of CPF that was confirmed by pathological examination had symptoms that could be attributable to embolization. In the group of 45 patients with a presumed diagnosis of CPF, 3 patients had symptoms that were likely due to embolization (incidence, 6.6%) during a follow-up period of 552+/-706 days.CPFs are generally small and single, occur most often on valvular surfaces, and may be mobile, resulting in embolization. Because of the potential for embolic events, symptomatic patients, patients undergoing cardiac surgery for other lesions, and those with highly mobile and large CPFs should be considered for surgical excision.

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Primary cardiac tumors: early and late results of surgical treatment in 91 patients

1999-10-01

Paolo Centofanti , Elio Di Rosa , Luca Deorsola +7 more

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Fetal and Neonatal Cardiac Tumors

2004-04-15

Hart Isaacs

Clinical and Molecular Features of the Carney Complex: Diagnostic Criteria and Recommendations for Patient Evaluation

2001-09-01

Constantine A. Stratakis , Lawrence S. Kirschner , J. Aidan Carney

Carney complex is a multiple neoplasia syndrome featuring cardiac, endocrine, cutaneous, and neural tumors, as well as a variety of pigmented lesions of the skin and mucosae. Carney complex is … Carney complex is a multiple neoplasia syndrome featuring cardiac, endocrine, cutaneous, and neural tumors, as well as a variety of pigmented lesions of the skin and mucosae. Carney complex is inherited as an autosomal dominant trait and may simultaneously involve multiple endocrine glands, as in the classic multiple endocrine neoplasia syndromes 1 and 2. Carney complex also has some similarities to McCuneAlbright syndrome, a sporadic condition that is also characterized by multiple endocrine and nonendocrine tumors. Carney complex shares skin abnormalities and some nonendocrine tumors with the lentiginoses and certain of the hamartomatoses, particularly Peutz-Jeghers syndrome, with which it shares mucosal lentiginosis and an unusual gonadal tumor, large-cell calcifying Sertoli cell tumor. Careful clinical analysis has enabled positional cloning efforts to identify two chromosomal loci harboring potential candidate genes for Carney complex. Most recently, at the 17q22–24 locus, the tumor suppressor gene PRKAR1A, coding for the type 1α regulatory subunit of PKA, was found to be mutated in approximately half of the known Carney complex kindreds. PRKAR1A acts a classic tumor suppressor gene as demonstrated by loss of heterozygosity at the 17q22–24 locus in tumors associated with the complex. The second locus, at chromosome 2p16, to which most (but not all) of the remaining kindreds map, is also involved in the molecular pathogenesis of Carney complex tumors, as demonstrated by multiple genetic changes at this locus, including loss of heterozygosity and copy number gain. Despite the known genetic heterogeneity in the disease, clinical analysis has not detected any corresponding phenotypic differences between patients with PRKAR1A mutations and those without. This article summarizes the clinical manifestations of Carney complex from a worldwide collection of affected patients and also presents revised diagnostic criteria for Carney complex. In light of the recent identification of mutations in the PRKAR1A gene, an estimate of penetrance and recommendations for genetic screening are provided.

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Papillary Fibroelastoma: Echocardiographic Characteristics for Diagnosis and Pathologic Correlation

1997-07-01

Kyle W. Klarich , Maurice Enriquez‐Sarano , George M. Gura +3 more

Frequency of primary tumors of the heart

1996-01-01

K Reynen

Metastatic Cancer to the Heart

1960-09-01

STANLEY M. HANFLING

A review of the literature of metastatic cancer to the heart is presented, and a new classification offered. Autopsy data of The New York Hospital have been analyzed. In the … A review of the literature of metastatic cancer to the heart is presented, and a new classification offered. Autopsy data of The New York Hospital have been analyzed. In the 7-year period, 1947 to 1953, in 694 deaths from cancer, an over-all incidence of 18.3 per cent (127 cases) of metastases to the heart was observed. In a group of 169 cases of lymphoma, leukemia, and myeloma, there was an incidence of 36 per cent (61 cases) of metastases to the heart. In the remaining 525 cases, there was an incidence of 12.6 per cent (66 cases) of metastases to the heart. In 61 of these, gross lesions were present, an incidence of 11.6 per cent (61 cases) of gross metastases to the heart. These figures are comparable to those reported in other series.

Carney complex, a familial multiple neoplasia and lentiginosis syndrome. Analysis of 11 kindreds and linkage to the short arm of chromosome 2.

1996-02-01

Constantine A. Stratakis , J A Carney , Jing‐Ping Lin +5 more

Carney complex is an autosomal dominant syndrome characterized by multiple neoplasias, including myxomas at various sites and endocrine tumors, and lentiginosis. The genetic defect(s) responsible for the complex remain(s) unknown. … Carney complex is an autosomal dominant syndrome characterized by multiple neoplasias, including myxomas at various sites and endocrine tumors, and lentiginosis. The genetic defect(s) responsible for the complex remain(s) unknown. We studied 101 subjects, including 51 affected members, from 11 North American kindreds with Carney complex. Blood samples were collected from patients and their family members. Hospital records, photographs, and tissue specimens of deceased individuals were reviewed. DNA was extracted from blood samples, patient-derived cell lines, and/or paraffin-embedded tissues. Linkage analysis was performed with highly polymorphic microsatellite markers, distributed over areas of the human genome harboring the most likely candidate genes. The most prevalent clinical manifestation in patients with Carney complex was spotty skin pigmentation, similar to that observed in Peutz-Jeghers and other lentiginosis syndromes. Skin and cardiac myxomas, Cushing syndrome, and acromegaly were present in 62, 30, 31 and 8 percent of the patients, respectively. Linkage was obtained for three markers on the short arm of chromosome 2 (2p16), with a maximum two-point lod score of 5.97 at theta = 0.03 for the marker CA-2 (odds in favor of linkage 10(6):1. The flanking markers CA7 and D2S378 defined a region of approximately 6.4 cM that is likely to contain the gene(s) associated with Carney complex. Candidate genes in the proximity, including the propiomelanocortin and the DNA-mismatch repair hMSH2 genes, were excluded. We conclude that the genetic defect(s) responsible for Carney complex map(s) to the short arm of chromosome 2 (2p16). This region has exhibited cytogenetic aberrations in atrial myxomas associated with the complex, and has been characterized by microsatellite instability in human neoplasias.

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Embolic potential, prevention and management of mural thrombus complicating anterior myocardial infarction: A meta-analysis

1993-10-01

Paul T. Vaitkus , Elliot S. Barnathan

Clinical, imaging, and pathological characteristics of left ventricular thrombus: A comparison of contrast-enhanced magnetic resonance imaging, transthoracic echocardiography, and transesophageal echocardiography with surgical or pathological validation

2006-07-01

Monvadi B. Srichai , Chelif Junor , L. Leonardo Rodriguez +6 more

Pediatric primary benign cardiac tumors: A 15-year review

1997-12-01

Maurice Beghetti MDa , Robert M. Gow , Isabel Haney +3 more

Primary cardiac sarcomas

1991-06-01

Joe B. Putnam , Michael S. Sweeney , Rolando Colon +3 more

Sarcomas of the great vessels. A clinicopathologic study

1993-03-01

Allen Burke , Renu Virmani

There are few reports comparing the clinicopathologic features of sarcomas of the aorta (SA), sarcomas of the inferior vena cava (SIVC), and sarcomas of the pulmonary artery (SPA).The authors retrospectively … There are few reports comparing the clinicopathologic features of sarcomas of the aorta (SA), sarcomas of the inferior vena cava (SIVC), and sarcomas of the pulmonary artery (SPA).The authors retrospectively reviewed 11 SA, 16 SIVC, and 16 SPA, and compared clinical, pathologic, and immunohistochemical findings.The mean age at presentation for SA was 62.3 +/- 17.3 years versus 41.3 +/- 17.1 for SPA; mean age for SIVC was 49.9 +/- 18.8. Nine of 11 SA and 14 of 16 SPA were grossly confined to the lumen, compared with only two SIVC. Luminal sarcomas were classified as poorly differentiated (intimal), angiosarcoma or leiomyosarcoma. Eight SA, 13 SPA, and one SIVC were of the intimal type and were composed of fibroblastic or myofibroblastic cells; five had "storiform" areas typical of malignant fibrous histiocytoma, and all had areas of necrosis. Intimal SPA were more likely myxoid than SA, and osteosarcomatous differentiation was present only in SPA (three cases). Intimal sarcomas were negative for desmin, Factor VIII-related antigen, S-100 protein, and CD34/QBend; all were positive for vimentin and most showed positive cells for smooth muscle actin. One luminal SA and one luminal SPA were histologically typical of angiosarcoma. Two SPA, 2 SA, and 14 SIVC were predominantly mural, most of which were leiomyosarcomas. The mean survival of intimal SA was poor (5 months), compared with 37 months for SIVC and 23 months for intimal SPA.SA, SPA, and SIVC differ in their clinical presentation and survival. Most SA and SPA sarcomas are aggressive, probably derived from intimal cells that show myofibroblastic differentiation. SIVC are usually derived from medial smooth muscle and are relatively well differentiated leiomyosarcomas.

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Ischemic Stroke in Adults Younger Than 30 Years of Age

1987-05-01

Julien Bogousslavsky

Because the cause and prognosis of ischemic stroke in adults younger than 30 years of age are not known, we observed 41 such patients (26 females and 15 males) using … Because the cause and prognosis of ischemic stroke in adults younger than 30 years of age are not known, we observed 41 such patients (26 females and 15 males) using a standard protocol of investigations, including cerebral angiography and echocardiography. Mitral valve prolapse and arterial dissection accounted for 51% of infarcts, migrainous infarction was the likely cause in 15% of infarcts, and uncommon causes accounted for 34% of infarcts. Atherosclerosis played a role in only two patients. Two thirds of the women were taking oral contraceptives, which may have been the primary cause of stroke in one woman who had recurrent venous thromboses followed by thrombosis of the aortic arch. Three patients (7.3%) died of acute causes. During follow-up (mean, 46 months), the annual incidence of death (0.7%) and recurrent stroke (0.7%) was low. Eighty-one percent of the survivors could return to work. We conclude that cerebral angiography and echocardiography are indicated in all adults younger than 30 years of age. After the acute phase of stroke, prognosis is reasonable.

Mutations in Regulatory Subunit Type 1A of Cyclic Adenosine 5′-Monophosphate-Dependent Protein Kinase (<i>PRKAR1A</i>): Phenotype Analysis in 353 Patients and 80 Different Genotypes

2009-03-18

Jérôme Bertherat , Anélia Horvath , Lionel Groussin +7 more

The "complex of myxomas, spotty skin pigmentation, and endocrine overactivity," or "Carney complex" (CNC), is caused by inactivating mutations of the regulatory subunit type 1A of the cAMP-dependent protein kinase … The "complex of myxomas, spotty skin pigmentation, and endocrine overactivity," or "Carney complex" (CNC), is caused by inactivating mutations of the regulatory subunit type 1A of the cAMP-dependent protein kinase (PRKAR1A) gene and as yet unknown defect(s) in other gene(s). Delineation of a genotype-phenotype correlation for CNC patients is essential for understanding PRKAR1A function and providing counseling and preventive care.A transatlantic consortium studied the molecular genotype and clinical phenotype of 353 patients (221 females and 132 males, age 34 +/- 19 yr) who carried a germline PRKAR1A mutation or were diagnosed with CNC and/or primary pigmented nodular adrenocortical disease.A total of 258 patients (73%) carried 80 different PRKAR1A mutations; 114 (62%) of the index cases had a PRKAR1A mutation. Most PRKAR1A mutations (82%) led to lack of detectable mutant protein (nonexpressed mutations) because of nonsense mRNA mediated decay. Patients with a PRKAR1A mutation were more likely to have pigmented skin lesions, myxomas, and thyroid and gonadal tumors; they also presented earlier with these tumors. Primary pigmented nodular adrenocortical disease occurred earlier, was more frequent in females, and was the only manifestation of CNC with a gender predilection. Mutations located in exons were more often associated with acromegaly, myxomas, lentigines, and schwannomas, whereas the frequent c.491-492delTG mutation was commonly associated with lentigines, cardiac myxomas, and thyroid tumors. Overall, nonexpressed PRKAR1A mutations were associated with less severe disease.CNC is genetically and clinically heterogeneous. Certain tumors are more frequent, with specific mutations providing some genotype-phenotype correlation for PRKAR1A mutations.

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MR Imaging of Cardiac Tumors and Masses: A Review of Methods and Clinical Applications

2013-06-21

Manish Motwani , Ananth Kidambi , Bernhard A. Herzog +3 more

Cardiac masses are usually first detected at echocardiography. In their further evaluation, cardiac magnetic resonance (MR) imaging has become a highly valuable technique. MR imaging offers incremental value owing to … Cardiac masses are usually first detected at echocardiography. In their further evaluation, cardiac magnetic resonance (MR) imaging has become a highly valuable technique. MR imaging offers incremental value owing to its larger field of view, superior tissue contrast, versatility in image planes, and unique ability to enable discrimination of different tissue characteristics, such as water and fat content, which give rise to particular signal patterns with T1- and T2-weighted techniques. With contrast material-enhanced MR imaging, additional tissue properties such as vascularity and fibrosis can be demonstrated. MR imaging can therefore contribute to the diagnosis of a cardiac mass as well as be used to detail its relationship to other cardiac and extracardiac structures. These assessments are important to plan therapy, such as surgical intervention. In addition, serial MR studies can be used to monitor tumor regression after surgery or chemotherapy. Primary cardiac tumors are very rare; metastases and pseudotumors (eg, thrombus) are much more common. This article provides an overview of cardiac masses and reviews the optimal MR imaging techniques for their assessment.

Primary Cardiac and Pericardial Neoplasms: Radiologic-Pathologic Correlation

2000-07-01

Mary L. Grebenc , M.L. Rosado de Christenson , Allen Burke +2 more

Primary cardiac and pericardial neoplasms are rare lesions and include both benign and malignant histologic types. Myxoma is the most frequent primary cardiac neoplasm, but other benign tumors include papillary … Primary cardiac and pericardial neoplasms are rare lesions and include both benign and malignant histologic types. Myxoma is the most frequent primary cardiac neoplasm, but other benign tumors include papillary fibroelastoma, rhabdomyoma, fibroma, hemangioma, lipoma, and paraganglioma. Cardiac sarcoma represents the second most common primary cardiac neoplasm. Lymphoma can also affect the heart primarily. Pericardial tumors that affect the heart include benign teratomas and malignant mesotheliomas. Patients affected with cardiac or pericardial neoplasms often present with cardiovascular compromise or embolic phenomena and exhibit cardiomegaly at chest radiography. Benign cardiac tumors typically manifest as intracavitary, mural, or epicardial focal masses, whereas malignant tumors demonstrate invasive features and may involve the heart diffusely. Benign lesions can usually be successfully excised, but patients with malignant lesions have an extremely poor prognosis.

Genetic heterogeneity and spectrum of mutations of the PRKAR1A gene in patients with the Carney complex

2000-12-01

Lawrence S. Kirschner , Fabiano Sandrini , Juahdi Monbo +3 more

Carney complex (CNC) is an autosomal dominant multiple neoplasia syndrome, which has been linked to loci on 2p16 and 17q22-24. We recently reported that PRKAR1A, which codes for the type … Carney complex (CNC) is an autosomal dominant multiple neoplasia syndrome, which has been linked to loci on 2p16 and 17q22-24. We recently reported that PRKAR1A, which codes for the type 1A regulatory subunit of protein kinase A (PKA), is a tumor suppressor gene on chromosome 17 that is mutated in some CNC families. To evaluate the spectrum of PRKAR1A mutations, we identified its genomic structure and screened for mutations in 54 CNC kindreds (34 families and 20 patients with sporadic disease). Fourteen families were informative for linkage analysis: four of four families that mapped to 17q had PRKAR1A mutations, whereas there were no mutations found in seven families exhibiting at least one recombination with 17q. In six of the latter, CNC mapped to 2p16. PRKAR1A mutations were also found in 12 of 20 non-informative families and 7 of 20 sporadic cases. Altogether, 15 distinct PRKAR1A mutations were identified in 22 of 54 kindreds (40.7%). In 14 mutations, the sequence change was predicted to lead to a premature stop codon; one altered the initiator ATG codon. Mutant mRNAs containing a premature stop codon were unstable, as a result of nonsense-mediated mRNA decay. Accordingly, the predicted truncated PRKAR1A protein products were absent in these cells. We conclude that (i) genetic heterogeneity exists in CNC; and (ii) all of the CNC alleles on 17q are functionally null mutations of PRKAR1A. CNC is the first human disease recognized to be caused by mutations of the PKA holoenzyme, a critical component of cellular signaling.

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CT and MR Imaging of Benign Primary Cardiac Neoplasms with Echocardiographic Correlation

2000-09-01

Philip A. Araoz , Sharon L. Mulvagh , Henry D. Tazelaar +2 more

Benign primary cardiac neoplasms are rare but may cause significant morbidity and mortality. However, they are usually treatable and can often be diagnosed with echocardiography, computed tomography (CT), or magnetic … Benign primary cardiac neoplasms are rare but may cause significant morbidity and mortality. However, they are usually treatable and can often be diagnosed with echocardiography, computed tomography (CT), or magnetic resonance (MR) imaging. Myxomas typically arise from the interatrial septum from a narrow base of attachment. Fibroelastomas are easily detected at echocardiography as small, mobile masses attached to valves by a short pedicle. Cardiac fibromas manifest as a large, noncontractile, solid mass in a ventricular wall at echocardiography and as a homogeneous mass with soft-tissue attenuation at CT. They are usually homogeneous and hypointense on T2-weighted MR images and isointense relative to muscle on T1-weighted images. Paragangliomas usually appear as large, echogenic left atrial masses at echocardiography and as circumscribed, heterogeneous masses with low attenuation at CT. These tumors are usually markedly hyperintense on T2-weighted MR images and iso- or hypointense relative to myocardium on T1-weighted images. Cardiac lipomas manifest at CT as homogeneous, low-attenuation masses in a cardiac chamber or in the pericardial space and demonstrate homogeneous increased signal intensity that decreases with fat-saturated sequences at T1-weighted MR imaging. Cardiac lymphangiomas manifest as cystic masses at echocardiography and typically demonstrate increased signal intensity at T1- and T2-weighted MR imaging. Familiarity with these imaging features and with the relative effectiveness of these modalities is essential for prompt diagnosis and effective treatment.

Primary cardiac valve tumors

1991-11-01

Fred H. Edwards , Douglas A. Hale , Amram J. Cohen +3 more

Cardiac tumours: diagnosis and management

2005-04-01

Jagdish Butany , Vidhya Nair , Ather Naseemuddin +3 more

Carney complex: an update

2015-07-01

Ricardo Correa , Calvin Ke , Constantine A. Stratakis

Carney complex (CNC) is a rare autosomal dominant syndrome, characterized by pigmented lesions of the skin and mucosa, cardiac, cutaneous and other myxomas and multiple endocrine tumors. The disease is … Carney complex (CNC) is a rare autosomal dominant syndrome, characterized by pigmented lesions of the skin and mucosa, cardiac, cutaneous and other myxomas and multiple endocrine tumors. The disease is caused by inactivating mutations or large deletions of the PRKAR1A gene located at 17q22–24 coding for the regulatory subunit type I alpha of protein kinase A (PKA) gene. Most recently, components of the complex have been associated with defects of other PKA subunits, such as the catalytic subunits PRKACA (adrenal hyperplasia) and PRKACB (pigmented spots, myxomas, pituitary adenomas). In this report, we review CNC, its clinical features, diagnosis, treatment and molecular etiology, including PRKAR1A mutations and the newest on PRKACA and PRKACB defects especially as they pertain to adrenal tumors and Cushing's syndrome.

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Primary and Secondary Neoplasms of the Heart

1997-09-01

William C. Roberts

Cardiac troponin-I is not expressed in fetal and healthy or diseased adult human skeletal muscle tissue

1995-12-01

G. Bodor , D. Marshall Porterfield , Ellen M. Voss +2 more

Cardiac troponin-I (cTnI) is not found in sera of patients with skeletal muscle disease in the absence of myocardial injury. It is not known, however, whether trace amounts of cTnI … Cardiac troponin-I (cTnI) is not found in sera of patients with skeletal muscle disease in the absence of myocardial injury. It is not known, however, whether trace amounts of cTnI are expressed in regenerating human skeletal muscle, as has been observed with creatine kinase MB. Using immunohistochemical and biochemical techniques, we investigated cTnI expression in various human muscle tissues: human heart tissue (n = 5), normal adult skeletal muscle (n = 3), and fetal heart (n = 3) and skeletal muscle (n = 3) obtained, respectively, during heart transplant, from autopsy, or from a tissue bank. Specimens from diagnostic tissue biopsies were used as diseased skeletal muscle: polymyositis (PM), n = 13; Duchenne muscular dystrophy (DMD), n = 6. Frozen sections 8 microns thick were stained immunohistochemically for either cTnI or TnI (cardiac or skeletal) by using monoclonal antibodies (MAb) 2B1.9 (cTnI specific) or 3C5.10 (reactive with all TnI isoforms), respectively. cTnI was measured in tissue homogenates by an immunofluorometric assay. Cardiac muscle was stained by both MAbs. Normal fetal and adult skeletal muscle, and samples from all of the PM and DMD patients, stained only with the nonspecific MAb (3C5.10), confirming the sole presence of skeletal TnI. No cTnI was detectable by immunoassay in any skeletal muscle sample. We conclude that cTnI is not expressed in human skeletal muscle during development or during regenerative muscle disease processes such as PM or DMD.

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MR Imaging of Cardiac Tumors

2005-09-01

Patrick Sparrow , John B Kurian , Tim R. Jones +1 more

Magnetic resonance (MR) imaging is an important tool in the evaluation of cardiac neoplasms. T1-weighted, T2-weighted, and gadolinium-enhanced sequences are used for anatomic definition and tissue characterization, whereas cine gradient-echo … Magnetic resonance (MR) imaging is an important tool in the evaluation of cardiac neoplasms. T1-weighted, T2-weighted, and gadolinium-enhanced sequences are used for anatomic definition and tissue characterization, whereas cine gradient-echo imaging is used to assess functional effects. Recent improvements in pulse sequences for cardiac MR imaging have led to superior image quality, with reduced motion artifact and improved signal-to-noise ratio and tissue contrast. Although there is some overlap in the MR imaging appearances of cardiac tumors, particularly of primary malignancies, differences in characteristic locations and features should allow confident differentiation between benign and malignant tumors. Indicators of malignancy at MR imaging are invasive behavior, involvement of the right side of the heart or the pericardium, tissue inhomogeneity, diameter greater than 5 cm, and enhancement after administration of gadolinium contrast material (as a result of higher tissue vascularity). Concomitant pericardial or pleural effusions are rare in benign processes but occur in about 50% of cases of malignant tumors. MR imaging offers improved resolution, a larger field of view, and superior soft-tissue contrast compared with those of echocardiography, suggesting that knowledge of the MR imaging features of cardiac neoplasms is important for accurate diagnosis and management.

Clinical and molecular genetics of patients with the Carney–Stratakis syndrome and germline mutations of the genes coding for the succinate dehydrogenase subunits SDHB, SDHC, and SDHD

2007-08-01

Barbara Pasini , Sarah R. McWhinney , Thalia Bei +7 more

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Metastases to the heart

2004-03-01

K Reynen , Ulrich Köckeritz , R. H. Strasser

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Left ventricular thrombus formation after acute myocardial infarction

2012-11-14

Ronak Delewi , Felix Zijlstra , Jan J. Piek

Cardiovascular disease remains the leading cause of death in western society. Mortality from acute myocardial infarction (AMI) has decreased since the introduction of primary percutaneous coronary intervention (PCI), which has … Cardiovascular disease remains the leading cause of death in western society. Mortality from acute myocardial infarction (AMI) has decreased since the introduction of primary percutaneous coronary intervention (PCI), which has proved to be superior to thrombolytic therapy by demonstrating lower mortality rates and reduced clinical adverse events. Nevertheless, postinfarct complications still lead to morbidity and mortality in a large number of patients. One of the most feared complications is the occurrence of thromboembolic events (mostly cerebrovascular accidents) due to left ventricular (LV) thrombus formation. The risk of LV thrombus formation is highest during the first 3 months following acute myocardial infarction, but the potential for cerebral emboli persists in the large population of patients with chronic LV dysfunction. Since these thromboembolic events are usually unheralded by warning signs of transient cerebral ischaemia, the only truly satisfactory medical approach is adequate management of these high risk groups. This article discusses the incidence, diagnosis and management of LV thrombus formation after an AMI. The combination of blood stasis, endothelial injury and hypercoagulability, often referred to as Virchow's triad, is a prerequisite for in vivo thrombus formation. In the presence of LV thrombus formation after AMI, the three components of this triad can also be recognised (figure 1). LV regional wall akinesia and dyskinesia result in blood stasis, often recognised on two dimensional echocardiography by the occurrence of spontaneous LV contrast. Prolonged ischaemia leads to subendocardial tissue injury with inflammatory changes. Finally, patients with an acute coronary syndrome display a hypercoagulable state with, for example, increased concentrations of prothrombin, fibrinopeptide A, and von Willebrand factor, and decreased concentrations of the enzyme responsible for cleaving von Willebrand factor (ADAMTS13).w1 w2 This triad can result in the formation of LV thrombus composed …

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CT and MR Imaging of Primary Cardiac Malignancies

1999-11-01

Philip A. Araoz , H E Eklund , Tasha L. Welch +1 more

Primary cardiac malignancies are rare tumors that are difficult to diagnose clinically. Different primary cardiac malignancies may have different clinical, morphologic, and radiologic features and intracardiac locations. Angiosarcoma is the … Primary cardiac malignancies are rare tumors that are difficult to diagnose clinically. Different primary cardiac malignancies may have different clinical, morphologic, and radiologic features and intracardiac locations. Angiosarcoma is the most common primary cardiac malignancy. It tends to occur in the right atrium and involve the pericardium. Because of its tendency to hemorrhage, angiosarcoma often demonstrates areas of increased signal intensity with T1-weighted sequences. Undifferentiated sarcomas typically occur in the left atrium and have variable epidemiologic and radiologic features. Rhabdomyosarcoma is the most common primary cardiac malignancy in children and is more likely than other primary cardiac sarcomas to involve the valves. Primary cardiac osteogenic sarcoma almost always occurs in the left atrium and frequently demonstrates calcification. Certain features (eg, broad base of attachment, origin at a site other than the atrial septum) help differentiate this tumor from left atrial myxoma. Leiomyosarcoma favors the left atrium and tends to invade the pulmonary veins and mitral valve. Fibrosarcoma also tends to occur in the left atrium and is often necrotic. Liposarcoma is very rare and usually manifests as a large, infiltrating mass. Foci of macroscopic fat are occasionally seen. Primary cardiac lymphoma occurs more commonly in immunocompromised patients, frequently involves the pericardium, and, unlike other primary cardiac malignancies, may respond to chemotherapy. The advent of cross-sectional imaging has allowed earlier detection of primary cardiac malignancies as well as more accurate diagnosis and characterization.

Comparison of High-Dose with Low-Dose Subcutaneous Heparin to Prevent Left Ventricular Mural Thrombosis in Patients with Acute Transmural Anterior Myocardial Infarction

1989-02-09

Alexander G.G. Turpie , John G. Robinson , D. John Doyle +7 more

We performed a double-blind randomized trial comparing high doses of subcutaneous heparin (12,500 units every 12 hours) with low doses (5000 units every 12 hours) for 10 days in the … We performed a double-blind randomized trial comparing high doses of subcutaneous heparin (12,500 units every 12 hours) with low doses (5000 units every 12 hours) for 10 days in the prevention of left ventricular mural thrombosis in 221 patients with acute anterior myocardial infarction. Left ventricular mural thrombosis was observed by two-dimensional echocardiography on the 10th day after infarction in 10 of 95 patients (11 percent) in the high-dose group and in 28 of 88 patients (32 percent) in the low-dose group (P = 0.0004). One patient in the high-dose group and four in the low-dose group had nonhemorrhagic strokes (P = 0.17). One patient in the low-dose group had a fatal pulmonary embolism. There was no difference in the frequency of hemorrhagic complications, which occurred in six patients in the high-dose group and four in the low-dose group. The mean (±SEM) plasma heparin concentration was 0.18±0.017 U per milliliter in the high-dose group and 0.01 ±0.005 U per milliliter in the low-dose group (P<0.0001). In the high-dose group, the mean plasma heparin concentration was 0.10±0.029 U per milliliter among patients with abnormal two-dimensional echocardiograms, as compared with 0.19±0.019 U per milliliter among patients with normal echocardiograms (P = 0.01). We conclude that heparin administered subcutaneously in a dosage of 12,500 units every 12 hours to patients with acute anterior transmural myocardial infarction is more effective than a lower dosage (5000 units every 12 hours) in preventing left ventricular mural thrombosis. (N Engl J Med 1989; 320:352–7.)

Incidence of Left-Ventricular Thrombosis after Acute Transmural Myocardial Infarction

1981-08-06

Richard Asinger , Frank L. Mikell , Joseph Elsperger +1 more

To study the incidence of left-ventricular thrombosis after transmural myocardial infarction, we performed serial two-dimensional echocardiography in 70 consecutive patients. Thirty-five patients had inferior-wall infarction: none had a left-ventricular thrombus. … To study the incidence of left-ventricular thrombosis after transmural myocardial infarction, we performed serial two-dimensional echocardiography in 70 consecutive patients. Thirty-five patients had inferior-wall infarction: none had a left-ventricular thrombus. The other 35 had anterior-wall infarction: 12 had left-ventricular thrombi. Thrombi were diagnosed an average of five days after the infarction (range, one to 11 days). All patients with left-ventricular thrombi had severe apical-wall-motion abnormalities (akinesis or dyskinesis). Twenty-six of the 35 patients with anterior infarctions had apical akinesis or dyskinesis on echocardiography; left-ventricular thrombi developed in 12 of these 26 (46 per cent). We conclude that patients with severe apical-wall-motion abnormalities during acute transmural anterior myocardial infarction are at high risk for left-ventricular thrombosis. This high-risk group can be identified before the development of left-ventricular thrombi. Patients with inferior infarction or anterior infarction without a severe apical-wall-motion abnormality are at low risk.

A macro and micro view of coronary vascular insult in ischemic heart disease.

1990-09-01

Davies Mj

Atherosclerotic plaques are either concentric, producing a fixed degree of obstruction, or eccentric, with retention of an arc of normal vessel wall that allows changes in medial muscle tone to … Atherosclerotic plaques are either concentric, producing a fixed degree of obstruction, or eccentric, with retention of an arc of normal vessel wall that allows changes in medial muscle tone to vary the degree of stenosis. Plaques may also either be solid and fibrous or may contain, in addition to fibrous thickening, a pool of extracellular cholesterol. Most subjects with ischemic heart disease have mixtures of all plaque types. The endothelium over established human plaques often shows focal denudation injury, with adhesion of a platelet monolayer not detectable by angiography. Larger thrombi are due either to superficial intimal injury, which is the progression of the endothelial denudation seen over otherwise static and intact plaques, or to deep intimal injury caused by plaque fissuring (rupture). Both forms of intimal injury expose collagen and von Willebrand factor to platelets. In deep injury, tears extend from the lumen into the depths of the intima and often enter a lipid pool; in consequence, thrombus initially forms within the plaque, thereby altering its configuration and expanding its volume. Many fissures will reseal at this stage, but the plaque is larger, and the process is an important cause of episodic sudden plaque growth. A proportion of plaque fissures are associated with the additional formation of a luminal thrombus, which may be either mural or occlusive. In life, transitions between mural and occlusive thrombi and vice versa occur rapidly and frequently. Mural thrombus is associated with distal embolization of platelet masses and, in some cases, is associated with cholesterol from the plaque.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical Progress

1980-02-01

Norman A. Silverman

Cardiac tumors are a rare, but potentially curably form of heart disease. A high index of clinical suspicion is necessary for diagnosis as these tumors have protean manifestations that mimic … Cardiac tumors are a rare, but potentially curably form of heart disease. A high index of clinical suspicion is necessary for diagnosis as these tumors have protean manifestations that mimic a variety of other cardiac and noncardiac diseases. Presently, M-mode and two-dimensional echocardiography are utilized as safe, reliable, and noninvasive imaging modalities. Seventy-five per cent of these tumors are benign, with myxoma accounting for 50% and rhabdomyoma comprising 20% of lesions. Various histologic types of sarcoma are the predominant malignant cardiac neoplasms. With strict attention to avoiding perioperative tumor embolization, surgical resection of these lesions can be accomplished with minimal morbidity and mortality. Sixteen consecutive primary tumors of the heart have been surgically treated at Duke University Medical Center since 1966 with no perioperative deaths and no late recurrences.

Primary Tumors of the Heart

1955-06-01

Henry P. Goldberg , Israel Steinberg

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Cardiac Tumors

2020-06-01

Sara Tyebally , Daniel Chen , Sanjeev Bhattacharyya +6 more

Cardiac masses are rare, but remain an important component of cardio-oncology practice. These include benign tumors, malignant tumors (primary and secondary) and tumor-like conditions (e.g., thrombus, Lambl's excrescences, and pericardial … Cardiac masses are rare, but remain an important component of cardio-oncology practice. These include benign tumors, malignant tumors (primary and secondary) and tumor-like conditions (e.g., thrombus, Lambl's excrescences, and pericardial cyst). The advent of multimodality imaging has enabled identification of the etiology of cardiac masses in many cases, especially in conjunction with information from clinical settings. This paper provides a comprehensive review of the epidemiology, clinical presentation, imaging, diagnosis, management, and outcomes of cardiac masses.

Cardiac metastases

2006-11-10

Rossana Bussani , Fabio De‐Giorgio , Antonio Abbate +1 more

Tumours metastatic to the heart (cardiac metastases) are among the least known and highly debated issues in oncology, and few systematic studies are devoted to this topic. Although primary cardiac … Tumours metastatic to the heart (cardiac metastases) are among the least known and highly debated issues in oncology, and few systematic studies are devoted to this topic. Although primary cardiac tumours are extremely uncommon (various postmortem studies report rates between 0.001% and 0.28%), secondary tumours are not, and at least in theory, the heart can be metastasised by any malignant neoplasm able to spread to distant sites. In general, cardiac metastases are considered to be rare; however, when sought for, the incidence seems to be not as low as expected, ranging from 2.3% and 18.3%. Although no malignant tumours are known that diffuse preferentially to the heart, some do involve the heart more often than others—for example, melanoma and mediastinal primary tumours. This paper attempts to review the pathophysiology of cardiac metastatic disease, epidemiology and clinical presentation of cardiac metastases, and pathological characterisation of the lesions.

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Ferromagnetismus

1939-01-01

Richard Becker , W. Döring

Cardiac metastases

1990-03-15

Edward C. Klatt , Daniel R. Heitz

The authors found metastases to the heart in 10.7% of 1029 autopsy cases in which a malignant neoplasm was diagnosed. The lung was the commonest primary site (36.4%) and adenocarcinoma … The authors found metastases to the heart in 10.7% of 1029 autopsy cases in which a malignant neoplasm was diagnosed. The lung was the commonest primary site (36.4%) and adenocarcinoma was the most frequent cell type (36.4%) of neoplasms metastatic to heart. Nonepithelial tumors accounted for 22.7% of cardiac metastases. Epicardium was involved in 75.5% of metastatic lesions and a pericardial effusion was present with 33.7% of epicardial metastases. Although hemorrhagic effusions occurred in only 12 cases with metastases to heart, these represented 76.4% of all such effusions. Lymphomas associated with the acquired immune deficiency syndrome showed the most extensive cardiac involvement. Primary sites and cell types of cardiac metastases have evolved over time and have been modified by chemotherapy, increased survival of cancer patients, increasing incidence of lung carcinoma, and recently by the acquired immune deficiency syndrome epidemic.

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Cardiac Myxomas

1995-12-14

K Reynen

Primary tumors of the heart are rare, with an incidence between 0.0017 and 0.19 percent in unselected patients at autopsy.15 Three quarters of the tumors are benign.1,68 Nearly half the … Primary tumors of the heart are rare, with an incidence between 0.0017 and 0.19 percent in unselected patients at autopsy.15 Three quarters of the tumors are benign.1,68 Nearly half the benign heart tumors are myxomas, and the majority of the rest are lipomas, papillary fibroelastomas, and rhabdomyomas. Fibromas, hemangiomas, teratomas, and mesotheliomas of the atrioventricular node are found less frequently; granular-cell tumors, neurofibromas, and lymphangiomas are very rare.6 Whereas rhabdomyomas are the most common primary tumors of the heart in children, myxomas clearly predominate in adults.A left atrial myxoma was first described in 1845.9 Before 1951, . . .

Tumors of the Cardiovascular System.

1980-02-01

Hugh A. McAllister , John J. Fenoglio

Book reviews 99 grafts.There is a section on experimental work on the treatment of aplastic anaemia by ALG and a section on clinical bone marrow transplantation.This covers histocompatibility testing and … Book reviews 99 grafts.There is a section on experimental work on the treatment of aplastic anaemia by ALG and a section on clinical bone marrow transplantation.This covers histocompatibility testing and the H-Y immunity phenomenon.The clinical results of marrow grafting for aplasia, leukaemia, and immune deficiency are reported from Seattle, UCLA, and Paris, but they are already out of date.The final section of the book is a mixed bag called 'Advances in Experimental Haematology' covering a variety of topics including preservation of dog granulocytes and diffusion chamber cul- tures.All in all this is a specialised book providing suitable reading for the growing number of experimental haematologists concerned with investigating new approaches to understanding and treating leukaemia, aplastic anaemia, and immune deficiencies.It is a good memento of the conference but, like all proceedings, its useful life must be measured in months not years.It is not for the uninitiated who would do better to wait for a definitive review on the last decade of experimental haematological research.

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Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies.

1993-10-01

Alfred K. Lam , Paul Dickens , A. C. L. Chan

Cardiac involvement by primary and secondary tumors is one of the least investigated subjects in oncology. Seven cases of primary and 154 cases of secondary cardiac tumors from autopsies performed … Cardiac involvement by primary and secondary tumors is one of the least investigated subjects in oncology. Seven cases of primary and 154 cases of secondary cardiac tumors from autopsies performed over a 20-year period (1972 through 1991) at Queen Mary Hospital, Hong Kong, were reviewed. During this period, 12,485 autopsies were performed, and the autopsy incidence for primary and secondary heart tumors is thus 0.056% and 1.23%, respectively. Only seven primary cardiac tumors were found, including two myxomas, two rhabdomyomas, two hemangiomas, and one lipoma. For secondary tumors involving the heart (including both metastasis and local extension), important primary tumors in male subjects were carcinoma of the lung (31.7%), esophageal carcinoma (28.7%), lymphoma (11.9%), carcinoma of the liver (6.9%), leukemia (4.0%), and gastric carcinoma (4.0%), while in female subjects, carcinoma of the lung (35.9%), lymphoma (17.0%), carcinoma of the breast (7.5%), and pancreatic carcinoma (7.5%) predominated. Overall, the three most common malignant neoplasms encountered were carcinoma of the lung, esophageal carcinoma, and lymphoma. Pericardium, including epicardium, was the most common location of cardiac involvement by secondary tumors, followed by myocardium and endocardium. The present study showed a higher percentage of esophageal carcinoma and carcinoma of the liver (reflecting the higher incidence of these tumors in Hong Kong Chinese), but a lower incidence of carcinoma of the breast when compared with other series. The metastatic lung tumors showed an unusual predominance of adenocarcinoma.

Correction: Cardiac metastasis in papillary thyroid carcinoma: a case report and literature review

2025-06-25

X.F. Zhang , Xinyu Huang | Frontiers in Oncology

The role of endosonography in cardiac tumor assessment: a case report

2025-06-25

Abdelrahman Elhakim , Fred Heinisch , Mohamed Elhakim +5 more | The International Journal of Cardiovascular Imaging

Cardiac Involvement in Thoracic Lymphoma

2025-06-24

Rossana Izzo , Daniela Campanale , Mattia Duchini +3 more | Clinical Case Reports

ABSTRACT This case highlights the role of cardiac imaging in detecting the evolution of cardiac involvement during thoracic lymphoma and the importance of optimal chemotherapy, which leads to a rapid … ABSTRACT This case highlights the role of cardiac imaging in detecting the evolution of cardiac involvement during thoracic lymphoma and the importance of optimal chemotherapy, which leads to a rapid improvement of the cardiac dysfunction, without the need for cardiac pharmacotherapy.

Metastatic Cardiac Angiosarcoma Presenting as Superior Vena Cava Syndrome and Cardiac Tamponade.

2025-06-24

Som Singh , Naa Korkor Koppoe , Afsana Islam +1 more | PubMed

Tumor thrombus related acute ischemic stroke in oral sarcoma patient - a rare case and literature review

2025-06-24

Ying-Li Lin , Christopher P. Cheng | International Journal of Oral and Maxillofacial Surgery

Infected Odontoma: A Preoperative Risk in Cardiac Surgery

2025-06-24

Ashok Paul | International Journal of Oral and Maxillofacial Surgery

Embolic complications of paediatric atrial myxoma

2025-06-24

Isa Frederick Ghaidan , Reuben Onyebuchi Mbajekwe , Andrew Parry +2 more | Archives of Disease in Childhood

Hämodynamisch relevantes kardiales Rezidiv eines diffusen großzelligen B-Zell-Lymphoms

2025-06-24

Jan-Niklas Krohn , Christina Bermel , David Nisenbaum +1 more | Deleted Journal

A 55-year-old female patient presented with a 1-week history of cough, dyspnea, pre-syncopal sensation and a history of asthma and long-lasting complete remission of diffuse large B‑cell lymphoma (LBCL). Imaging … A 55-year-old female patient presented with a 1-week history of cough, dyspnea, pre-syncopal sensation and a history of asthma and long-lasting complete remission of diffuse large B‑cell lymphoma (LBCL). Imaging revealed a mass measuring 8 × 6.4 × 6.2 cm in the right ventricle and atrium, partially obstructing the cardiac valve plane. Biopsy was performed. With the onset of hemodynamic instability, ex juvantibus antineoplastic therapy was administered. After 36 h, echocardiography already showed a considerable size reduction to approximately 5 × 5 cm. Histology was consistent with relapsed LBCL. Staging showed no further manifestations and salvage therapy was initiated.

A rare case of a primary atrial myxoma with metaplastic ossification and its multimodal imaging features

2025-06-23

Nathan Siewert , M Frenkel , Timothy M. Guenther +1 more | International Journal of Surgery Case Reports

A Review of Intracardiac Mass Cases Encountered Over a Two-Year Period

2025-06-23

Shinji Akishima | Cureus

Surgical treatment of giant metastatic myxoid liposarcoma of the pericardium

2025-06-23

Р. Н. Комаров , Ashot Simonyan , Maxim I. Tkachev +1 more | Russian Journal of Cardiology and Cardiovascular Surgery

The authors present surgical treatment of giant liposarcoma invading myocardium of the left atrium. The authors present surgical treatment of giant liposarcoma invading myocardium of the left atrium.

Long-term asymptomatic course of large myxoma in the right atrium

2025-06-23

С. А. Чепурненко , M. Yu. Kostrykin , Г. В. Шавкута +1 more | Russian Journal of Cardiology and Cardiovascular Surgery

Myxoma arising from the right atrium accounts for 7—18% of all these tumors. Any myxoma is characterized by classic triad of symptoms with blood flow obstruction, constitutional signs and thromboembolic … Myxoma arising from the right atrium accounts for 7—18% of all these tumors. Any myxoma is characterized by classic triad of symptoms with blood flow obstruction, constitutional signs and thromboembolic phenomena. We present a rare variant of asymptomatic course of large myxoma in the right atrium in a 65-year-old man. The tumor was discovered accidentally when the patient visited the clinic due to long-term uncontrollable paroxysm of atrial fibrillation. The neoplasm was attached to anterior wall of the right atrium and did not reach tricuspid annulus. There were no symptoms of blood flow obstruction. We performed direct myocardial revascularization, resection of the right atrial tumor, ligation of the left atrial appendage and tricuspid valve annuloplasty. The tumor was a node 4.5×5 x 4.5 cm with grayish-brown tuberous surface. Histological analysis revealed myxoid tissue with confluent hemorrhages and hemorrhagic impregnation, necrosis and foci of lymphoplasmacytic infiltration. This case is of interest due to rare localization of myxoma in the right atrium and asymptomatic course of disease.

Palpitations and Lipothymia in a Diabetic Patient: Unveiling a Mitral Myxoma

2025-06-23

Mehdi Rochd , hamdani zainab , hajar hatim +1 more | Research Square (Research Square)

<title>Abstract</title> Mitral myxomas are rare benign tumors that typically originate in the left atrium, with a higher prevalence in women aged 30-60 years. They can cause a wide range of … <title>Abstract</title> Mitral myxomas are rare benign tumors that typically originate in the left atrium, with a higher prevalence in women aged 30-60 years. They can cause a wide range of symptoms, including palpitations, lipothymia, and embolic events, depending on their size, location, and mobility. Early detection and surgical resection are critical for a favorable outcome.We present the case of a 60-year-old woman with a history of hypertension and type 2 diabetes who presented with recurrent lipothymia and palpitations. Physical examination revealed sinus tachycardia at 120 bpm, with stable hemodynamics and no signs of acute decompensation. Transthoracic echocardiography revealed a mass near the mitral valve, measuring 33 mm x 22 mm, highly suggestive of a mitral myxoma. The patient underwent successful surgical resection of the mass via a median sternotomy. The procedure was uneventful, and the patient recovered well without complications. At one year after surgery, the patient was asymptomatic, with no recurrence of palpitations or lipothymia. Serial echocardiograms showed no evidence of residual tumor or mitral valve dysfunction. Her hypertension and diabetes were better controlled, contributing to her positive recovery. This case highlights the importance of considering cardiac tumors, such as mitral myxomas, in patients presenting with unexplained palpitations and lipothymia. Early diagnosis through imaging and timely surgical intervention can lead to excellent outcomes. Clinicians should be vigilant in recognizing cardiac masses, particularly in patients with predisposing cardiovascular risk factors.

Hemodynamic Collapse Due to Leiomyosarcoma: Intracardiac Obstruction as a Trigger for Multiorgan Dysfunction

2025-06-21

Cisneros Ramón Guadalupe Antonia , Oliver Mayorga Luis Carlos , Aly Karen +1 more | International Journal of Medical Science and Clinical Research Studies

We present a malignant intracardiac tumor causing hemodynamic collapse and multiorgan dysfunction. The uncommon clinical presentation included progressive dyspnea associated with recurrent pleural effusions, initially approached as rheumatologic disease due … We present a malignant intracardiac tumor causing hemodynamic collapse and multiorgan dysfunction. The uncommon clinical presentation included progressive dyspnea associated with recurrent pleural effusions, initially approached as rheumatologic disease due to renal failure, serositis, anemia, and thrombocytopenia. The patient experienced positional syncope, biventricular cardiogenic shock, severe jugular distension, collateral circulation, edema, and pulmonary congestion requiring advanced life support. Echocardiography revealed a myxoid mass in the left atrium protruding through the mitral valve, significantly affecting cardiac function. Surgical resection achieved temporary remission, with histopathology confirming epithelioid leiomyosarcoma. However, prognosis remains poor due to high recurrence and therapeutic resistance.

Preoperative embolization of head and neck tumors: a systematic review and meta-analysis

2025-06-20

Zhen Long , Y. J. Su , Jun Zhu +6 more | World Journal of Surgical Oncology

Preoperative embolization is a widely recognized adjunctive treatment for highly vascular head and neck tumors; however, there is still no consensus regarding its efficacy and safety. Our study aims to … Preoperative embolization is a widely recognized adjunctive treatment for highly vascular head and neck tumors; however, there is still no consensus regarding its efficacy and safety. Our study aims to address this issue through a meta-analysis. A comprehensive search was conducted in the PubMed, Embase, Web of Science, and Cochrane databases to identify relevant literature on preoperative embolization for head and neck tumors up to March 2025. Randomized controlled trials, cohort studies, and case-control studies involving embolization and non-embolization groups were included. Eligible studies were selected for meta-analysis to estimate intraoperative blood loss, operative time, and postoperative complications. Data were analyzed using Review Manager 5.4 software. A total of 30 studies met the inclusion criteria, including 7 randomized controlled trials and 23 cohort studies, encompassing a total of 1,039 patients. Preoperative embolization reduced estimated blood loss. The estimated blood loss was 456 ml in the embolization group compared to 516 ml in the non-embolization group (Standard Mean Difference = -0.67; 95% CI: -1.02 to -0.32; P = 0.0002). Preoperative embolization was associated with increased surgical resection time. The mean resection time was 312 min in the embolization group and 305 min in the non-embolization group (Standard Mean Difference = -0.66; 95% CI: -1.21 to -0.12; P = 0.02). Preoperative embolization did not reduce postoperative complications (Odd ratio = 1.06; 95% CI: 0.42, 2.70; P = 0.90). Compared with surgery without preoperative embolization for head and neck tumors, preoperative embolization appears to reduce intraoperative estimated blood loss and increase surgical resection time; however, it does not significantly reduce incidence of complications.

Application of Transcatheter Arterial Chemoembolization (TACE) and Transarterial Chemoinfusion (TACI) in Sarcoma: A Case Series

2025-06-18

Adrian Tangkilisan , Wega Sukanto , Christa Tamburian +1 more | e-CliniC

Abstract: Sarcomas are rare cancers with a dismal prognosis, and are still a great challenge for surgeons. Moreover, the development of treatment methods for sarcomas is currently heterogeneous. Transcatheter arterial … Abstract: Sarcomas are rare cancers with a dismal prognosis, and are still a great challenge for surgeons. Moreover, the development of treatment methods for sarcomas is currently heterogeneous. Transcatheter arterial chemoembolization (TACE) is a procedure that combines embolization and transarterial infusion chemotherapy (TACI). It targets the tumor bed with high doses of cytotoxic medicines while also inducing ischemia necrosis through arterial embolization. We presented a case series of patients treated with TACE and TACI for sarcoma. Two male patients with soft tissue sarcoma treated at Prof. Dr. R. D. Kandou Hospital, Manado. A 48-year-old male patient presented clinically with pain sensation and venectation in the right chest area, was diagnosed with thoracic soft tissue sarcoma. Another 72-year-old male complained of a painful lump and ulcers at the right flank area was diagnosed with right flank sarcoma. Both of these patients underwent the TACE and TACI procedure. Treatment outcome was assessed by examining the clinical morphology of the lesions and which showed a significant tumor reduction. According to the medical literature, TACE and TACI can benefit some patients, but TACE therapy's effectiveness in treating advanced STS, however, remains debatable. In conclusion, TACE and TACI were used as therapies in the two cases described, with a focus on the most recent developments and discussion of the need for more research to increase the efficacy of therapies. Keywords: transcatheter arterial chemoembolization; transarterial infusion chemotherapy; sarcoma

Left atrial mass detected by cardiac ultrasonography – myxoma or something else?

2025-06-16

Mijo Meter | Medical Ultrasonography

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Type B Right Ventricular Thrombus With Postmortem Computed Tomography and Postmortem Examination Correlation

2025-06-16

Gulshan Bhatia , Samantha Waugh , Rexson Tse | American Journal of Forensic Medicine & Pathology

Multiorgan involvement and genetic spectrum of 20 Chinese patients with PMM2-CDG

2025-06-15

Huiting Zhang , Jingtao Zhang , Wanlong Ma +7 more | Molecular Genetics and Metabolism

Rapid On-Site Cytologic Evaluation-Facilitated Diagnosis of Fibrin-Associated Large B-Cell Lymphoma in a Right Atrial Fibrin Thrombus: A Case Report

2025-06-13

Koichi Oga , Chiyuki Tagawa , Yuki Teramoto +5 more | Case Reports in Oncology

Background: Fibrin-associated large B-cell lymphoma (FA-LBCL) is a rare extranodal lymphoma confined to fibrin deposits within cardiovascular structures and other anatomically restricted spaces. Due to its non-mass-forming nature and nonspecific … Background: Fibrin-associated large B-cell lymphoma (FA-LBCL) is a rare extranodal lymphoma confined to fibrin deposits within cardiovascular structures and other anatomically restricted spaces. Due to its non-mass-forming nature and nonspecific clinical presentation, preoperative diagnosis remains challenging. Case Presentation: A 47-year-old woman with a history of mitral valve repair and pacemaker implantation presented with a right atrial mass extending from the coronary sinus. A catheter-based biopsy with rapid on-site cytologic evaluation (ROSE) revealed scattered large atypical lymphoid cells. Histology confirmed FA-LBCL, composed of CD20-positive cells with a high Ki-67 index (~90%) and negative EBV-encoded RNA. Despite no myocardial invasion, the patient opted for six cycles of R-CHOP and remains disease-free two years post-diagnosis. Conclusion: This case highlights the diagnostic utility of ROSE in FA-LBCL, particularly in guiding sample adequacy and expediting ancillary studies. Given the focal and sparse distribution of neoplastic cells, early recognition through ROSE may prevent misdiagnosis and unnecessary procedures. As EBV-negative FA-LBCL represents a distinct entity with evolving molecular insights, further research is warranted to delineate its pathogenesis and optimal management strategies.

Abstract P1-10-30: Pulmonary vein thrombi in metastatic breast cancer: a management dilemma

2025-06-13

Kriti Ahuja , Riya Patel , Jayasree Krishnan +1 more | Clinical Cancer Research

Abstract Background: Pulmonary Vein thrombosis (PVT) is an infrequently reported complication in oncology, particularly so in breast cancer, with potentially devastating complications particularly due to the risk for intracardiac extension, … Abstract Background: Pulmonary Vein thrombosis (PVT) is an infrequently reported complication in oncology, particularly so in breast cancer, with potentially devastating complications particularly due to the risk for intracardiac extension, systemic embolization and potential stroke. We present what we believe to be the second reported case in literature. PVT may be asymptomatic or present with cough, hemoptysis, dyspnea, weight loss, pleuritic chest pain or rarely with transient ischemic attack/stroke, end organ infarction or sudden cardiac death. It is diagnosed by imaging including CT Chest, echocardiogram, or occasionally cardiac MRI. There is no clear consensus on management strategy and it usually entails a multidisciplinary approach with surgical resection, systemic or radiation therapy to reduce tumor burden, as well as anticoagulation. Case Presentation: Here, we share our experience with extensive PVT with cardiac extension in a patient with metastatic triple negative breast cancer and a systematic review of similar cases reported to date. Our patient was a 63 year old female with ER/PR negative HER2 low (1+ by IHC) breast cancer initially diagnosed as pT3 N0 Mx, managed surgically, who subsequently developed recurrence with metastatic disease to left upper lobe of the lung). She progressed on multiple systemic treatments, including atezolizumab with nab paclitaxel, eribulin, capecitabine, sacituzumab govitecan, and a clinical trial. She was also initiated on therapeutic anticoagulation with apixaban for a PICC line thrombus. While on trastuzumab deruxtecan, a restaging scan demonstrated development of tumor thrombus in the left superior pulmonary vein which progressed to involve the left atrium. At the time, anticoagulation was continued and surgical management deferred. Given the development of tumor thrombus, in order to control further invasion into the heart, the thrombus was irradiated and systemic therapy was switched to carboplatin and gemcitabine, with resultant partial response. To prevent further growth and invasion of the tumor thrombus, a complete sternotomy, left atrial thrombectomy, left upper lobectomy and ligation of superior pulmonary vein was performed. Pathology of the left atrial mass was consistent with metastatic breast cancer. She recovered well from the surgery with a well healed surgical site. Later, due to infection at the surgical site, she developed sepsis which excluded her from active treatment. Discussion: We performed an extensive literature search which revealed that most cases occurred in lung cancer, or in metastasis from choriocarcinoma, leiomyosarcoma, hepatocellular cancer, or renal cancer among others. Only one such case in breast cancer seems to reported thus far. We evaluated management strategies in 21 cases which included resection occasionally followed by chemotherapy/radiation (11) with 1 mortality from perioperative stroke, chemoradiation (2), chemotherapy (4), gamma knife radiation therapy (1). Two patients died without any cancer-directed treatment. The patient with breast cancer underwent embolectomy, thereafter, opting for domiciliary care. Some patients received anticoagulation[RP1] in combination with cancer directed care. Overall, surgical resection appears to be the most common approach, followed by chemotherapy, chemoradiation and radiation, respectively with similar success rates in the cases we reviewed. Anticoagulation is usually utilized as a temporizing measure when employed. Conclusion: PVT in metastatic breast cancer is an extremely rare but lethal complication. Early diagnosis and multimodal approach, focusing on treatment of underlying malignancy to reduce the disease burden with careful consideration of risks and benefits of surgery is essential in treating these patients. Citation Format: Kriti Ahuja, Riya Patel, Jayasree Krishnan, Shipra Gandhi. Pulmonary vein thrombi in metastatic breast cancer: a management dilemma [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P1-10-30.

SCA con elevación del ST: impacto del tiempo al diagnóstico en el tiempo puerta-balón en el mundo real. Datos del registro ARGEN-IAM-ST

2025-06-11

Yanina Castillo Costa , Flavio Delfino , Víctor Mauro +7 more | Revista Argentina de Cardiología

Introducción: El tiempo trascurrido desde el inicio de los síntomas de infarto hasta el diagnóstico (TAD) puede influir en lograr un tiempo puerta-balón (TPB) <90 min. Material y métodos: Análisis … Introducción: El tiempo trascurrido desde el inicio de los síntomas de infarto hasta el diagnóstico (TAD) puede influir en lograr un tiempo puerta-balón (TPB) <90 min. Material y métodos: Análisis retrospectivo que incluyó 1518 pacientes ingresados en forma prospectiva y consecutiva al registro ARGEN-IAM-ST. El 37,8% de ellos fue tratado con un TPB <90 min y el TAD (mediana) fue de 120 min (RIC 60-266). Se dividió a la población de acuerdo al TAD en dos grupos: menor de 120 min y mayor o igual que 120 min. Un TPB <90 min se logró más frecuentemente en el primer grupo (TAD <120 min): 44%, vs. 32,2% en el segundo grupo (p <0,001). Resultados: En el 56% de los pacientes con ATC in situ y TAD <120 min se logró un TPB <90 min, vs. en el 37,1% de quienes tuvieron un TAD >120 min (p <0,001). En pacientes derivados, no hubo diferencias en TPB <90 min de acuerdo al TAD: 27,5% vs. 25,7 (p: 0,3). En pacientes ingresados en horario laborable, el TPB <90 min se logró con TAD <120 min en un 49,8% vs. 36,3% con TAD >120 min (p: 0,003); la frecuencia siguió un patrón similar en los pacientes ingresados en horarios no laborables: 41,9% vs. 30,4%, respectivamente (p <0,001). Los predictores independientes de lograr un TPB <90 min en el análisis multivariado fueron la edad <75 años: OR 1,57 (1,1-2,25; p: 0,01), ATC en horario laborable: OR 1,32 (1,04-1,67; p: 0,002), ATC in situ: OR 2,4 (1,9-3,0; p <0,001), tener un ECG prehospitalario: OR 2,22 (1,73-2,86; p <0,001) y un TAD <120 min: OR 1,53 (1,23-1,9; p <0,001). Conclusiones: En los pacientes con un TAD <120 minutos se logra más frecuentemente un TPB <90 min, especialmente en los tratados in situ y en horario laborable. En los pacientes derivados, solo 1 de cada 3 logra un TPB <90 min y no hay relación con el TAD.

Diffuse Large B-Cell Lymphoma with Cardiac Metastasis: A Case Report

2025-06-05

Shi-Hua Yin , Dezhuan Da , Shuping Li | American Journal of Case Reports

NOTCH3 Drives Fatty Acid Oxidation and Ferroptosis Resistance in Aggressive Meningiomas

2025-06-04

Nishanth S. Sadagopan , Mateo Gomez , Ian Olson +7 more | Research Square (Research Square)

<title>Abstract</title> PURPOSE <italic>NOTCH3</italic> is increasingly implicated for its oncogenic role in many malignancies, including meningiomas. While prior work has linked <italic>NOTCH3</italic> expression to higher-grade meningiomas and treatment resistance, the metabolic … <title>Abstract</title> PURPOSE <italic>NOTCH3</italic> is increasingly implicated for its oncogenic role in many malignancies, including meningiomas. While prior work has linked <italic>NOTCH3</italic> expression to higher-grade meningiomas and treatment resistance, the metabolic phenotype of <italic>NOTCH3</italic> activation remains unexplored in meningioma. METHODS We performed single-cell RNA sequencing on NOTCH3 + human meningioma cell lines. Using the CH157-MN meningioma cell model, we overexpressed <italic>NOTCH3</italic> intracellular domain (ICD) and performed untargeted metabolomic, lipidomic, and bulk RNA sequencing analyses as well as functional metabolic assays. RESULTS We show that <italic>NOTCH3</italic> mediates a metabolic shift towards fatty acid oxidation (FAO), depleting lipid availability and conferring resistance to ferroptosis. Single-cell RNA sequencing revealed a correlation with CD36, a key fatty acid transporter. Furthermore, patient-derived primary meningioma lines stratified by <italic>NOTCH3</italic> expression confirmed higher <italic>CD36</italic> expression and increased maximal mitochondrial respiration in <italic>NOTCH3</italic>-high cells in the presence of palmitate, supporting enhanced FAO. <italic>NOTCH3</italic> ICD overexpression (OE) exhibited depletion of fatty acid pools, alongside transcriptional upregulation of canonical FAO genes. Functional mitochondrial assays confirmed elevated oxidative respiration in the presence of palmitate compared with controls. Additionally, <italic>NOTCH3</italic> OE cells exhibit increased resistance to RSL3-induced ferroptosis, a phenotype that was reversed with CPT1. CONCLUSION These data establish a link between <italic>NOTCH3</italic> signaling, lipid metabolic reprogramming, and ferroptosis evasion in aggressive meningioma cells. This metabolic shift may contribute to the malignant behavior observed in <italic>NOTCH3 +</italic> meningiomas, offering new insight into the biochemical vulnerabilities of these tumors.

A Rare Case of Atrioventricular Node Cystic Tumor

2025-06-04

K. Cheng , PS Law , T.-C. Chen +3 more | Scholars Journal of Medical Case Reports

Introduction: Cystic tumors of the atrioventricular (AV) node are exceptionally rare benign cardiac neoplasms with the potential to disrupt cardiac conduction, leading to complete heart block or sudden cardiac death. … Introduction: Cystic tumors of the atrioventricular (AV) node are exceptionally rare benign cardiac neoplasms with the potential to disrupt cardiac conduction, leading to complete heart block or sudden cardiac death. Due to their rarity and nonspecific clinical presentation, diagnosis often relies on multimodal imaging and histological confirmation. Case Presentation: We reported a case of 38-year-old woman who presented with an incidental complete heart block during hospitalization for community-acquired pneumonia. Imaging studies revealed a well-defined right atrial mass adjacent to the interatrial septum. Cardiac magnetic resonance imaging suggested a fibroma; however, intraoperative findings revealed a cystic, multi-septated mass in the triangle of Koch. The patient underwent successful minimally invasive right atrial mass excision. Histopathological examination confirmed a benign cystic tumor of the AV node. The patient recovered uneventfully and remained stable pending permanent pacemaker implantation. Conclusion: AV node cystic tumors, though benign, carry a high risk of conduction abnormalities and sudden cardiac death. Early detection and surgical intervention are crucial. This case highlights the utility of multimodal imaging and supports the feasibility and safety of minimally invasive cardiac surgery for tumor resection.

65 - Two-year follow-up of second-generation iTIND For BPH-related LUTS: Age-stratified subanalysis of the MT-06 multicenter prospective study

2025-06-01

Sabrina Titti De Cillis , Daniele Amparore , Alberto Quarà +7 more | Continence

Uncommon cardiac involvement in metastatic osteosarcoma

2025-06-01

Juan Manuel Serrano-Marcos , Víctor Manuel López-Espinosa , Míriam Cantero-Campos | Revista Española de Cardiología (English Edition)