Data for this review were found by searches of PubMed, and references from relevant articles using the search terms, “cardiac neoplasms”, “myxomas”, “metastatic heart neoplasms”, “angiosarcoma”, and “rhabdomyosarcoma”. Abstracts and reports from meetings were not included. Contemporary textbooks were reviewed. Only papers published in English between 1980 and 2004 were included.
ReviewCardiac tumours: diagnosis and management
Section snippets
Clinical features
Cardiac tumours have many clinical presentations and are known to be great mimickers (panel). Most patients have disseminated metastases, and the diagnosis is made incidentally during assessment of the primary lesion.5 Primary cardiac tumours present with one or more symptoms of the classic triad of: cardiac symptoms and signs resulting from intracardiac obstruction; signs of systemic embolisation; and systemic or constitutional symptoms.5, 6
Dyspnoea and orthopnoea from pulmonary venous
Cardiac myxomas
Cardiac myxomas are the commonest primary cardiac neoplasm in adults, with a mean age at diagnosis of 50 years, and 90% of patients are aged 30–60 years.9 They are found mainly in females,6 and usually arise in the atrial fossa ovalis region; about 75% arise in the left atrium, and 15–20% in the right atrium.5 An atrial myxoma sometimes obstructs the pulmonary or systemic venous drainage and interferes with valve function. Cardiac myxomas can cause recurrent strokes, peripheral or pulmonary
Diagnosis and monitoring
The techniques mainly used in diagnosis of cardiac lesions include transthoracic and transoesophageal echocardiogram, and MRI and CT scans. Echocardiography can quantify the tumour size, shape, attachment, and mobility, and can screen other cardiac chambers accurately for additional tumours.37 Before resection, transoesophageal echocardiography can reconfirm anatomical localisation, quantify baseline valvular stenosis or regurgitation, and guide cannulation.
Preoperative workup should include
Indications for and timing of surgery
Patients can undergo surgery for prognostic or symptomatic considerations. In most patients with benign tumours, or in those with resectable primary malignant disease and no evidence of metastasis, surgery is generally indicated to improve prognosis. By contrast, patients with a small right-sided papillary fibroelastoma,38 no symptoms, and without a patent foramen ovale or atrial septal defect can be managed non-surgically with continued echocardiographic follow-up. Patients with a primary
Search strategy and selection criteria
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