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Thorac Cardiovasc Surg 2019; 67(08): 659-664
DOI: 10.1055/s-0038-1667319
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Surgical Treatment of Cardiac Metastases: Analysis of a 13-Year Single-Center Experience

Sabreen Mkalaluh
1   Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
,
Marcin Szczechowicz
1   Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
,
Saeed Torabi
1   Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
,
Anton Sabashnikov
2   Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
,
Ahmed Mashhour
3   Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
,
Matthias Karck
1   Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
,
Alexander Weymann
1   Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
› Author Affiliations
Further Information

Publication History

01 April 2018

21 June 2018

Publication Date:
09 August 2018 (online)

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Abstract

Background Cardiac metastases are more common than primary malignant tumors of the heart and are usually treated surgically as a palliative approach. In this study, we reviewed our experience with the surgical treatment of patients with cardiac metastases of various types of malignant tumors.

Methods Between 2003 and 2016, 10 patients underwent surgery for cardiac metastases at our institution.

Results The mean age was 53.5 ± 19 years. Female patients made up 60% (n = 6) of the collective. The cohort included cardiac metastases of diverse origins (peripheral sarcomas, melanoma, rectal carcinoma, and hepatocellular carcinoma). The left side of the heart was more frequently affected (n = 7). In only six patients, the primary malignancy was known at the time of cardiac surgery. The interval between the first diagnosis of the primary tumor and cardiac metastases ranged from simultaneous diagnosis to up to 19 years. At the time of the diagnosis of the cardiac metastases, seven patients already had multiple metastases: all seven patients had pulmonary metastases, and three of them additionally had hepatic, cerebral, or osseous metastases. Only four patients were symptomatic (atrial fibrillation, pericardial effusion, tachycardia with chest pain, dyspnea). There was no in-hospital death. The postoperative course was uneventful overall. The one- and two-year survival rates were similar, that is, 76%. The median follow-up time was 5.4 years.

Conclusions Surgical intervention for treating cardiac metastases is associated with uneventful clinical outcome and acceptable survival in this critically ill population. Control of the primary malignancy, and maybe other metastases, determines the survival.

Keywords

cardiac metastases - surgery - palliative therapy
 

  • References

  • 1 Butany J, Nair V, Naseemuddin A, Nair GM, Catton C, Yau T. Cardiac tumours: diagnosis and management. Lancet Oncol 2005; 6 (04) 219-228
    CrossrefPubMedGoogle Scholar
  • 2 Goldberg AD, Blankstein R, Padera RF. Tumors metastatic to the heart. Circulation 2013; 128 (16) 1790-1794
    CrossrefPubMedGoogle Scholar
  • 3 Steger CM, Hager T, Ruttmann E. Primary cardiac tumours: a single-center 41-year experience. ISRN Cardiol 2012; 2012: 906109
    PubMedGoogle Scholar
  • 4 Reynen K, Köckeritz U, Strasser RH. Metastases to the heart. Ann Oncol 2004; 15 (03) 375-381
    CrossrefPubMedGoogle Scholar
  • 5 Hudzik B, Miszalski-Jamka K, Glowacki J. , et al. Malignant tumors of the heart. Cancer Epidemiol 2015; 39 (05) 665-672
    CrossrefPubMedGoogle Scholar
  • 6 Shapiro LM. Cardiac tumours: diagnosis and management. Heart 2001; 85 (02) 218-222
    CrossrefPubMedGoogle Scholar
  • 7 Tesolin M, Lapierre C, Oligny L, Bigras JL, Champagne M. Cardiac metastases from melanoma. Radiographics 2005; 25 (01) 249-253
    CrossrefPubMedGoogle Scholar
  • 8 Neragi-Miandoab S, Kim J, Vlahakes GJ. Malignant tumours of the heart: a review of tumour type, diagnosis and therapy. Clin Oncol (R Coll Radiol) 2007; 19 (10) 748-756
    CrossrefPubMedGoogle Scholar
  • 9 Nagasawa A, Koike T, Okamoto T, Namura O, Tsuchida M. Surgical resection for solitary myocardial metastasis of gastric cancer. Ann Thorac Surg 2016; 101 (05) 1978-1980
    CrossrefPubMedGoogle Scholar
  • 10 Murphy MC, Sweeney MS, Putnam Jr JB. , et al. Surgical treatment of cardiac tumors: a 25-year experience. Ann Thorac Surg 1990; 49 (04) 612-617 , discussion 617–618
    CrossrefPubMedGoogle Scholar
  • 11 Ravikumar TS, topulos GP, Anderson RW, Grage TB. Surgical resection for isolated cardiac metastases. Arch Surg 1983; 118 (01) 117-120
    PubMedGoogle Scholar
  • 12 Chiles C, Woodard PK, Gutierrez FR, Link KM. Metastatic involvement of the heart and pericardium: CT and MR imaging. Radiographics 2001; 21 (02) 439-449
    CrossrefPubMedGoogle Scholar
  • 13 Hoffmeier A, Sindermann JR, Scheld HH, Martens S. Cardiac tumors--diagnosis and surgical treatment. Dtsch Arztebl Int 2014; 111 (12) 205-211
    PubMedGoogle Scholar
  • 14 Mankad R, Herrmann J. Cardiac tumors: echo assessment. Echo Res Pract 2016; 3 (04) R65-R77
    CrossrefPubMedGoogle Scholar
  • 15 Coccia P, Ruggiero A, Rufini V. , et al. Cardiac metastases of Ewing sarcoma detected by 18F-FDG PET/CT. J Pediatr Hematol Oncol 2012; 34 (03) 236-238
    CrossrefPubMedGoogle Scholar
  • 16 Agrawal K, Mittal BR, Manohar K, Kashyap R, Bhattacharya A, Varma S. FDG PET/CT in detection of metastatic involvement of heart and treatment monitoring in non-Hodgkin's lymphoma. World J Nucl Med 2012; 11 (01) 33-34
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Pinnamaneni N, Muthukrishnan A. Left ventricular myocardium metastasis in a patient with primary renal cell carcinoma detected by 18F-FDG PET/CT. Clin Nucl Med 2012; 37 (07) e181-e183
    CrossrefPubMedGoogle Scholar
  • 18 Magarik MA, Walker RC, Gilbert J, Manning HC, Massion PP. Intracardiac metastases detected by 18F-FSPG PET/CT. Clin Nucl Med 2018; 43 (01) 28-30
    CrossrefPubMedGoogle Scholar
  • 19 Lichtenberger III JP, Reynolds DA, Keung J, Keung E, Carter BW. Metastasis to the heart: a radiologic approach to diagnosis with pathologic correlation. AJR Am J Roentgenol 2016; 207: 764-772
    CrossrefPubMedGoogle Scholar
  • 20 Takeda Y, Fujimoto R, Morita H. , et al. Cardiac metastasis of uterine cervical squamous cell Carcinoma: a case report and review of the literature. J Cardiol Cases 2014; 10: 221-225
    CrossrefPubMedGoogle Scholar
  • 21 Martinez C, Rana JS, Solomon MD. Cardiac metastasis of nonvisceral soft-tissue leiomyosarcoma. Rev Cardiovasc Med 2017; 18 (02) 78-81
    PubMedGoogle Scholar
  • 22 Noel A, Toquet C, Dewilde J. Prolonged survival after surgery for cardiac metastasis from malignant melanoma. J Cardiol Cases 2014; 10: 150-152
    CrossrefPubMedGoogle Scholar
  • 23 Pizzicannella J, Ricci V, Gorla R, Spinapolice E, Esposito A. Isolated cardiac metastasis from colorectal cancer in a 35-year-old man. Case Rep Med 2012; 2012: 751761
    PubMedGoogle Scholar
  • 24 Mansour Z, Gerelli S, Kindo MJ, Billaud PJ, Eisenmann B, Mazzucotelli JP. Right atrial metastasis from hepatocellular carcinoma. J Card Surg 2007; 22 (03) 231-233
    CrossrefPubMedGoogle Scholar
  • 25 Reisenauer JS, Said SM, Allen MS. Metastatic rectal adenocarcinoma presenting as a giant left atrial mass: resection combined with right lower lobectomy. Ann Thorac Surg 2016; 102 (01) e19-e21
    CrossrefPubMedGoogle Scholar
  • 26 Kim SB, Shin YC, Kwon SU. Isolated metastasis of hepatocellular carcinoma in the right ventricle: a case report. Medicine (Baltimore) 2016; 95 (51) e5544
    PubMedGoogle Scholar
  • 27 Ramchand J, Wong GR, Yudi MB, Sylivris S. Cardiac metastatic melanoma. BMJ Case Rep 2016; 2016: xx
    PubMedGoogle Scholar
  • 28 Hyeon J, Ahn S, Park CK. CHD1L is a marker for poor prognosis of hepatocellular carcinoma after surgical resection. Korean J Pathol 2013; 47 (01) 9-15
    CrossrefPubMedGoogle Scholar
  • 29 Topcu S, Gülcü O, Aksu U, Aksakal E. A rare life-threatening condition: metastasis to the heart. Am J Emerg Med 2016; 34 (09) 1912.e3-1912.e4
    CrossrefPubMedGoogle Scholar
  • 30 Choi PW, Kim CN, Chang SH, Chang WI, Kim CY, Choi HM. Cardiac metastasis from colorectal cancer: a case report. World J Gastroenterol 2009; 15 (21) 2675-2678
    CrossrefPubMedGoogle Scholar
  • 31 Parravicini R, Fahim NA, Cocconcelli F. , et al. Cardiac metastasis of rectal adenocarcinoma. Surgical treatment. Tex Heart Inst J 1993; 20 (04) 296-298
    PubMedGoogle Scholar
  • 32 Koizumi J, Agematsu K, Ohkado A, Shiikawa A, Uchida T. Solitary cardiac metastasis of rectal adenocarcinoma. Jpn J Thorac Cardiovasc Surg 2003; 51 (07) 330-332
    PubMedGoogle Scholar
  • 33 Providência R, Botelho A, Mota P, Catarino R, Leitão-Marques A. Cardiac mass in a patient with colorectal cancer: “not all that glitters is gold!”. World J Cardiol 2011; 3 (03) 98-100
    CrossrefPubMedGoogle Scholar