ORIGINAL ARTICLE  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2022 April;63(2):212-21

DOI: 10.23736/S0021-9509.21.12052-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Cardiac tumors: imaging findings, clinical correlations and surgical treatment in a 15 years single-center experience

Paola GRIPARI ¹ ✉, Mauro PEPI ¹, Laura FUSINI ¹, Gloria TAMBORINI ¹, Maria E. MANCINI ¹, Daniele ANDREINI ¹, Gianluca PONTONE ¹, Matteo SACCOCCI ², Ilaria GIAMBUZZI ¹, Francesco ALAMANNI ¹, Marco ZANOBINI ¹

¹ Centro Cardiologico Monzino IRCCS, Milan, Italy; ² Division of Cardiac Surgery, Poliambulanza Foundation, Brescia, Italy

BACKGROUND: The aims of this study were: to present the clinical and pathological characteristics of cardiac tumors in a single-center series of patients; to describe the association of imaging characteristics, clinical presentation and surgical treatment; to analyze if second level imaging tests, computed tomography (CT) and cardiac magnetic resonance (CMR); and to improve the diagnostic accuracy when compared to first-line imaging technique (transthoracic echocardiography [TTE]).
METHODS: We reviewed the medical and surgical records, TTE, CT and CMR examinations of 86 patients with a histological diagnosis of cardiac tumors between 2004 and 2019.
RESULTS: The majority were benign tumors (81%) with myxoma accounting for 66% of cases. Among malignancies, metastasis (8%) and primary tumors (10%) were equally recognized. Symptoms at presentation (45% of patients) were associated to larger diameters at TTE. Malignancies were larger (mean diameter 37±14 mm vs. 27±13 mm, P<0.01), more frequently exhibited irregular shape (67% vs. 17%, P<0.01), frayed or polylobulated surface (73% vs. 38%, P=0.035), heterogeneous aspect (67% vs. 32%, P=0.012). A maximum diameter >28 mm and a minimum diameter >19.5 mm emerged as possible cut-off values for the differentiation of benign and malignant tumors. The ability of TTE, CT and CMR features in identifying malignancies was moderate (diagnostic accuracy of 84%, 81%, 76% respectively). The mean survival time after surgery was 1.6±1.4 years in malignancies and 6.8±4.7 years in benign tumors.
CONCLUSIONS: Cardiac tumors are rare and mostly benign; their nature and clinics related to TTE appearance. CT and CMR may be used synergically with TTE. Surgery is curative in benign tumors, survival remains scarce in malignancies.

KEY WORDS: Heart neoplasms; Echocardiography; Cardiac surgical procedures