Cardiac Tumors: Diagnosis and Treatment
Medikoe Health Expert
Koramangala, bengaluru, karnataka, india, Bengaluru Feb 9, 2017
What is Cardiac Tumor?
Cardiac tumours can be primary or malignant. They can occur in any cardiac tissue and can cause valvular or inflow-outflow tract obstruction, thromboembolism, arrhythmias, or pericardial disorders.
Most tumours are benign, but even benign tumours cause problems because of their size and location. At fewer times, small pieces of tumour fall into the bloodstream and are carried to distant blood vessels and get in the way of blood flow to vital organs.
Classification of Primary Tumors
Primary cardiac tumours may be:
Benign (Nearly 80% of cases)
Malignant (Remaining 20%)
Benign Primary Tumors
Myxoma: It is most common and men are more affected by it. About 75% of myxomas occur in the left atrium, and the rest occur in the other chambers as a solitary tumour. They can be up to 15 cm in diameter. They may be myxoid and gelatinous, smooth, firm, and lobular or friable and irregular.
Papillary fibroelastomas: They are the 2nd most common benign primary tumor. They occur on the left side of the heart, predominantly on the aortic and mitral valves.
Rhabdomyomas: They account for 20% of all primary cardiac tumors and 90% of those in children. They are usually multiple and located intramurally in the septum or free wall of the left ventricle.
Fibromas: They mainly occur in children and are associated with adenoma sebaceum of the skin and kidney tumors. They occur primarily on the left side of the heart, are often located within the ventricular myocardium.
Hemangiomas: They account for 5 to 10 % of benign tumors.
Teratomas: They mainly affects infants and children and about 90% are located in the anterior mediastinum.
Lipomas: They occur in the endocardium or epicardium and have a large pedunculated base.
Paragangliomas: They are located at the base of the heart near vagus nerve endings.
Pericardial cysts: They resemble a cardiac tumor on chest X-ray.
Malignant Primary Tumors
Sarcoma: It is the most common malignant primary cardiac tumor and mainly affect middle-aged adults. Almost 40% are angiosarcomas which occur in the right atrium and involve the pericardium. Other types include undifferentiated sarcoma (25%), malignant fibrous histiocytoma (11 to 24%), leiomyosarcoma (8 to 9%), fibrosarcoma, rhabdomyosarcoma, liposarcoma, and osteosarcoma.
Pericardial mesothelioma: It is rare and affects all ages. It affects males more than females. It causes tamponade and constriction and can metastasize to the spine, adjacent soft tissues and heart failure.
Primary lymphoma: It is extremely rare and usually occurs in AIDS patients or other people with immunodeficiency.
Symptoms of Cardiac Tumors
It mostly happens that even a patient doesn’t know they have a cardiac tumour. The cardiac tumour is often found out when the patient echocardiogram for another reason. If the tumor is calcified then it may be seen on a chest x-ray. Most primary tumors are discovered when patients are in the late 50s. But cardiac tumors can be found in younger patients too.
Patients with cardiac myxoma in the left atrium develop cardiac tumor symptoms. Cardiac myxoma is caused due to blocked blood flow through the mitral valve. The blood flow may be blocked all the time or just when the patient lies down. It can result in shortness of breath, lightheadedness or a cough. The inflammation may result in fever and joint pain.
Causes of Cardiac tumors
A few people with cardiac tumors have a family history of the condition. Sometimes cardiac tumors can be part of another health condition, such as NAME syndrome, LAMB Syndrome or Carney Syndrome. Mostly the tumor develops as a result of cell overgrowth that either starts in the heart or moves to the heart.
Cardiac tumor Diagnosis
The doctor will order some tests to confirm the diagnosis. The tests include, echocardiogram computed tomography (CT) scan, magnetic resonance imaging (MRI), or radionuclide imaging.
Cardiac tumor Treatment
Generally, surgery is done to remove the tumor as it obstructs the blood flow. Whether surgery is required or not, it depends on the tumor size, symptoms and patient’s overall health.
Removal of cardiac tumor requires open-heart surgery. In many cases, surgery is done robotically or using minimally invasive technique. During th surgery, the surgeon removes the tumor and the tissue around it to reduce the risk of the tumor returning. As the surgery is complicated and requires a still heart, a heart-lung machine will be used to take over the work of your heart and lungs during surgery.
The recovery period after surgery is usually 4-5 days in the hospital, and 6 weeks of total recovery time. If the tumor is removed using a minimally invasive approach, your hospital stay will likely be shorter.
After surgery you will need to have an echocardiogram every year to make sure that the tumor has not returned and there are no new growths.