Journal of the Hong Kong College of Cardiology

Volume 12 Number 1 / 2, January / April 2004
Abstract

Surgery for Cardiac Tumors (Primary and Secondary) - Clinical Experience and Surgical Results in 22 Patients: Queen Elizabeth Hospital

Kar-wai Lam,1 Chan-chung Ma,1 Kwok-Keung Ho,1 Cheung-Wah ChENG,2 Kam-Tim Chan2
From 1Department of Cardiothoracic Surgery; 2Cardiology Division, Department of Medicine, Queen Elizabeth Hospital, Hong Kong

Lam et al.: Surgery for Cardiac Tumors (Primary and Secondary) - Clinical Experience and Surgical Results in 22 Patients: Queen Elizabeth Hospital. Purpose: Retrospective review of surgical management of the 22 cardiac tumors resected in Queen Elizabeth Hospital during the period of March 1995-December 2002. Methods: Presenting symptoms, diagnostic data, anatomical findings, surgical techniques, morbidity and complications of surgery were recorded. Follow up data was retrieved from out-patient records. Results: There were 12 male (54.5%) and 10 female (45.4%) patients. Median age was 61. 50% (11/22) of the cases were myxoma. Of the remaining cases, 27.3% (6/22) were various types of secondary metastastic tumor, 13.6% (3/22) were tumor of mediastinum with cardiac invasion, and 9.1% (2/23) were primary malignancy. Left sided masses were dominated by myxoma, which were sited either on the inter-atrial septum (81.8%) or left atrium (18.1%). All other tumor groups were found on the right side. Dyspnea (81.9%) was the most common presenting symptom, followed by chest pain (31.8%), embolic events (13.6%) and superior vena cava obstruction. All tumors were resected with cardiopulmonary bypass under moderate hypothermia, undertaken via either right atriotomy, superior septal and trans-septal with full thickness excision. The average cross-clamp time and bypass time were 48.6 minutes and 101.4 minutes respectively. The average blood loss was 813 ml. Post-operatively, 2 of the cases were complicated by junctional bradycardia and one of them required permanent pacing. Other complications including pericardial effusion, superior vena cava obstruction, pneumonia, secondary hemorrhage had been reported. The average follow up period was 40 months ranging from 3 months to 8 years. All patients with primary benign myxoma remained asymptomatic except one died 3 years after surgery. This patient had known co-existing history of breast cancer. She suffered from embolic complications and finally succumbed from multiple organ failure. All patients with secondary neoplasms died during the course of follow-up. One with germ cell tumor was lost to follow up. Survival for primary benign tumors and cardiac metastasis from secondary tumors, were 34 and 6 months respectively. The median survival of all tumors was 25 months. Surgical resection, when possible, is the treatment of choice for all patients with cardiac neoplasms. It is curative in benign tumors. On the other hand, palliative surgical procedures may be carried out for malignant tumors for relief of obstructive symptoms and allow time for adjuvant therapy. (J HK Coll Cardiol 2004;12:7-14)

Key words : Cardiac tumor, myxoma, superior septal approach, survival



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