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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2002 October;43(5):581-7

lingua: Inglese

Surgery for primary cardiac tumors. Clinical experience and surgical results in 60 patients

Kosuga T., Fukunaga S., Kawara T., Yokose S., Akasu K., Tayama E., Oryoji A, Aoyagi S.

Department of Surgery, Kurume University Hospital, Kurume University School of Medicine, Kurume, Japan


Background. We ­reviewed our clin­i­cal expe­ri­ence ­with pri­mary car­diac ­tumors, attempt­ing to clar­i­fy the sur­gi­cal man­age­ment of ­these ­rare ­entities.
Methods. Between October 1978 and November 1999, we expe­ri­enced 60 sur­gi­cal cas­es of pri­mary car­diac ­tumors. There ­were 23 ­male and 37 ­female ­patients (age ­range, 7 ­months to 84 ­years). Tumors includ­ed the fol­low­ing 3 ­groups: myx­o­mas (n=49), non­myx­o­ma ­benign ­tumors (n=3), and malig­nant ­tumors (n=8). We ­reviewed the pre­sent­ing symp­toms, diag­nos­tic ­data, ana­tom­i­cal find­ings, and sur­gi­cal tech­niques, and eval­u­at­ed the sur­gi­cal ­results. Late fol­low-up was 95% com­plete (­mean fol­low-up, 7.7±7.1 ­years).
Results. Tumors pro­duced obstruc­tive, embol­ic, and/or con­sti­tu­tion­al symp­toms in ­most cas­es. Generally, ech­o­car­di­og­ra­phy ­alone ­gave suf­fi­cient infor­ma­tion for oper­a­tion. Full-thick­ness exci­sion was per­formed in 42 ­patients ­with myx­o­ma. Complete exci­sion was ­achieved in all of the non­myx­o­ma ­benign tumors and in ­none of the malig­nan­cies. Early mor­tal­ities in the 3 ­groups ­were 8.2% (4/49), 0% (0/3), and 12.5% (1/8), respec­tive­ly. Late mor­tal­ities ­were 9.5% (4/42), 0% (0/3), and 100% (7/7), respec­tive­ly. One ­patient ­with myx­o­ma had recur­rence, the ­cause of ­which was like­ly to be inad­e­quate resec­tion. The ­late ­deaths in ­patients ­with malig­nan­cies ­were due to metas­ta­sis or ­local recur­rence.
Conclusions. Benign ­tumors are gen­er­al­ly cur­able if sur­gi­cal­ly ­excised. Preoperative refrac­to­ry car­diac dys­func­tion or embo­lism ­should be avoid­ed by the accu­rate eval­u­a­tion on ech­o­car­di­og­ra­phy. The prog­no­sis of malig­nant ­tumors is ­poor if ­they are ­only ­debulked. However, aggres­sive sur­gery ­that can pal­li­ate obstruc­tion and ­allow ­time for adju­vant ther­a­py ­should be car­ried out.

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