Summary
This report describes a series of 20 patients operated on for a primary cardiac tumour.
The majority of the tumours (16) were benign myxomas; 12 of them were located in the
left atrium, two in the right atrium and two were biatrial. Two lipomas were found;
one was epicardial and the other was located in the left atrium. The only intraventricular
tumour was a malignant left ventricular myosarcoma. The propensity of intracardiac
tumours to embolize was distinctive. Nine of the 16 myxomas presented with peripheral
embolization, and in two patients surgery was complicated by fatal perioperative cerebral
embolization of myxomatous tissue. Furthermore, in one patient embolization of a left
atrial lipoma necessitated amputation of her left arm before cardiac surgery. Late
postoperative recurrences were found in two patients with atrial myxomas. In one of
them, reoperation showed that the tumour had grown at that site in the interatrial
septum where the original pedicle had been excised. One patient developed severe mitral
valve regurgitation and underwent replacement with a prosthetic valve at reoperation.
Otherwise our late follow-up study showed that the results of surgery were usually
excellent even though mild echocardiographic abnormalities were not uncommon. Our
experience emphasizes the embolic potential of intracardiac myxomas and suggests,
furthermore, that to avoid recurrences excisions with wide margins should be preferred.
Echocardiography is an optimal method for the follow-up of these patients.
Zusammenfassung
Es wird über 20 Patienten mit einem primären Herztumor berichtet. Es handelte sich
um 16 benigne Myxome, 2 Lipome und 2 maligne Myosarkome. In der folgenden detaillierten
Darstellung wird sich auf die 16 Myxome konzentriert. Unter den 16 Myxomen kam es
9mal zu einer Tumorembolie in die Peripherie und in 2 Fällen kam es perioperativ zu
einer zerebralen Embolisation von myxomatösem Gewebe. Ein linksatriales Lipom verursachte
eine Tumorembolie in den linken Arm mit der Folge einer erforderlichen Amputation
dieser Extremität. In einem Myxomfall trat ein spätes postoperatives Rezidiv auf,
in einem anderen Fall machte eine postoperativ aufgetretene Mitralinsuffizienz den
Klappenersatz erforderlich. In den anderen 14 Fällen war das postoperative Resultat
gut, wenn auch gelegentlich geringe echokardiographische Abnormitäten festzustellen
waren. Die Autoren weisen besonders auf das Embolierisiko solcher Patienten hin und
betonen, daß eine ausreichend weite Exzision des Tumors im Gesunden mit dem Ziel der
Rezidivvermeidung erforderlich ist.
Key words
Heart tumour - Myxoma - Lipoma - Sarcoma - Embolization - Echocardiograpy
