Camilo Abdulmassih NetoI; Pedro R SalernoI; Jarbas J DinkhuysenI; Paulo ChaccurI; Antoninho S ArnoniI; M.M.B ZamoranoI; Adib D JateneII; Luiz Carlos Bento de SouzaI; Paulo P PaulistaI
DOI: 10.1590/S0102-76381992000200010
ABSTRACT
Fifty two patients with primary cardiac tumors were operated on at the Instituto Dante Pazzanese de Cardiologia between 1962 and 1991. Among the benign neoplasms, 43 were myxomas; the only two malignant tumors were rhabdomyosarcomas. The mean age of the patients was 41 years (range 15 days to 68 years); 33 patients were females and 19 males; 52.6% had congestive heart failure, 18% had chest pain or palpitation and 16% taquiarrhythmias. Complete resection was carried out in 50 patients. The two patients with malignant tumors had only been submitted to biopsy. All patients survived operation, although 3 died in the early postoperative period. One patient with myxoma presented recurrence three years after the innitial surgery and was reoperated on. The follow up data of 20 patients are available, all in NYHA functional class I. Longterm results were excellent in this group.RESUMO
No período de 1962 a 1991, no Instituto Dante Pazzanese de Cardiologia, foram tratados cirurgicamente 52 pacientes portadores de tumores primários do coração. Dentre os tumores benignos, 43 erammixomas, 5 fibromas, 1 fibroelastoma papilar, 1 rabdomioma e apenas 2 malignos (rabdomiossarcomas). A idade média foi de 41,1 anos; 33 pacientes eram do sexo feminino e 19 do masculino; 53,84% apresentaramse com insuficiência cardíaca congestiva, 19,2% com dor precordial e/ou palpitações e 17,3% com taquiarritmias. A ressecção completa do tumor foi possível em 50 pacientes e os 2 com tumores malignos foram apenas submetidos a biopsia. Todos os pacientes sobreviveram à cirurgia; entretanto, 3 pacientes foram a óbito no período hospitalar. Um paciente com mixoma apresentou recorrência três anos após e foi reoperado com sucesso. Temos em acompanhamento tardio 20 pacientes, que se encontram em classe funcional I (NYHA) e os resultados são bastante satisfatórios.REFERENCES
1. ANTUNES, M.J.; VANDERDONCH, K.M.; ANDRADE C.A.; REBELO, S.C. - Primary cardiac leiomyosarcomas. Am. Thorac. Surg., 5:999-1001, 1991.
2. ATHERTON, D.J.; PITCHER, D.W.; WELLS, R.S.; Mac DONALD, D.M. - A syndrome of cutaneous pigmented lesions, myxoid neurofibromas and atrial myxomas: The Name Syndrome. Br. J. Dermatol., 103:421-429, 1980. [MedLine]
3. ATTUM, A.A.; JOHNSON, G.S.; LAUSING, A.M. - Malignant clinical behavior of cardiac myxomas and "myxoid imitators". Ann. Thorac. Surg., 44:217-222, 1987. [MedLine]
4. BISEL, H.F.; WROBLEWSKI, F.; LA DUE, J.S.; - Incidence and clinical presentation of cardiac metastasis. Jama, 153:712-715, 1953.
5. BUDZILOVICH, G.; ALEKSIC, S.; GRECO, A. - Malignant cardiac myxona with cerebral metastases. Surg. Neurol., 11:461-470, 1979.
6. BURCH, G.E.; SHEWEY, L.L. ; HARB, J.M. - Coxsackie B4 viruses and atrial myxoma. Am. Heart J., 88:634-638, 1974.
7. CARNEY, J.A. - Differences between non-familial and familial cardiac myxoma. An. Surg. Pathol., 9:53-55, 1985.
8. COOLEY, D.A.; REARDON, M.J.; FRAZIER, O.H.; ANGELINA P. - Human cardiac explantation and auto-transplantation: application in a large cardiac pheochromocytoma. Texas Heart Inst. J., 9:1103-1105, 1985.
9. DEIN, J.R.; FRIST, W.H.; STINSON, E.B. - Primary cardiac neoplasmas: early and late results of surgical treatment in 42 patients. J. Thorac. Cardiovasc. Surg., 93:502-511, 1987. [MedLine]
10. DeSOUZA, A. L.; MULLER, J.T.; ROBERTSON, J.H. - Atrial myxoma: a review of the neurological complications, metastasis and recurrences. J. Neurol. Neurosurg. Psychiatry, 41:1119-1123, 1978.
11. EDWARDS, F. H.; HALE, D.; COHEN, A.; THOMPSON, L.; PEZZELLA, VIRMANI, R. - Primary cardiac valve tumors. Ann. Thorac. Surg., 52:1127-1131, 1991. [MedLine]
12. EISENMANN, B.; BAHEREL, B.; BOREISS, P.; JEANBLANC, B.; WARTER, J.; KIENY, R. - Les sarcomes primitifs de l'artère pulmonaire. Ann. Chir. Thorac. Cardiovasc., 16:315-322, 1977. [MedLine]
13. FOWLES, R. E.; MILLER, D.G.; EGBERT, R. M.; FITZGERALD, J. W.; POP, R. L. - Systemic embolization from a mitral valve papillary endocardial fibroma detected by two-dimensional echocardiografy. Am. Heart J., 102:128-130, 1981. [MedLine]
14. FENOGLIO Jr., J. J,; McALLISTER Jr., H. A; FERRANS, V. J. - Cardiac rabdomyoma: clinicopathologic and eletron microscopic study. Am. J. Cardiol., 38:241-251, 1976. [MedLine]
15. KARSAKIS, E. J.; O'CONNOR, W.; EARLE, G. - Embolic stroke from cardiac papillary fibroelastomas. Stroke, 19:1171:1173, 1988. [MedLine]
16. KIRKLIN, J. & BARRAT-BOYES, B. - Cardiac surgery: morfology, diagnostic criteria, natural history, techniques, results and indication. New York, Wiley Medical Publications, 1986. Cap. 50, p. 1993 -1407.
17. KRAUSE, S.; ADLER, L. N.; REDDY, P. S.; MAGOVERN, G. J. - Intracardiac myxoma in siblings. Chest, 60: 404-406, 1971. [MedLine]
18. McALLISTER, H.A. & FENOGLIO Jr., J.J. - Tumors of the cardiovascular system. In: Atlas of tumor pathology. Washington D.C., Armed Forces Institute of Pathology, 1978. Fascículo 15, série 2.
19. MAISCH, B. - Immunology of cardiac tumors. Thorac. Cardiovasc. Surg., 38 (Supl. 2):157-163, 1990. [MedLine]
20. MELLER, J.; TEICHHOLZ, L. E.; PICHARD, A. D. - Left ventricular mixoma: echocardiografic diagnosis and review of the literature. Am. J. Med., 63:816-823, 1977. [MedLine]
21. MIRALLES, A.; BRACAMONTE, L.; SONCUL, H.; DIAZ DEL CASTILLO, R.; AKTAR, R.; BORS, V.; PAVIE, A.; GRANDJBACKHCH, I.; CABROL, C. - Cardiac tumor: clinical experience and surgical results in 74 patients. Ann. Thorac. Surg, 52:886-895, 1991. [MedLine]
22. NADAS, A. S. & ELLISON, C. - Cardiac tumors in infancy. Am. J. Cardiol., 2:363-375, 1968.
23. POWERS, J. C.; FALKOFF, M.; HEINLE, R. A.; NANDA, N. C.; ONG, L.S.; WEINER, R. S.; BAROLD, S. S. - Familial cardiac mixoma: emphasis on unusual clinical manifestations. J. Thorac. Cardiovasc. Surg. 77:782-788, 1979. [MedLine]
24. PRICHARD, R.W. - Tumors of the heart: review of the subject and report of 150 cases. Arch. Pathol., 51:98-102, 1951.
25. READ, R. C.; WHITE, H. T.; MURPHY, M. C. - The malignant potentiality of left atrial mixoma. J. Thorac. Cardiovasc. Surg., 66:857-867, 1974.
26. RHODES, A. R.; SILVERMAN, R. A.; HARUST, T. J.; PEREZ-ATAYDE, A. R. - Mucocutaneous lentigines, cardiomucocutaneous mixomas and multiple blue nevi the Lamb syndrome. J. Am. Acort. Dermatol., 10:72-82, 1984
27. SEZAI, Y. - Tumors of the heart: incidence and clinical importance of cardiac tumors in Japan and operative technique for large left atrial mixomas. Thorac. Cardiovasc. Surg., 38 (Supl. 2):201-204, 1990. [MedLine]
28. SCHMALTZ, A. A. & APITZ, J. - Primary heart tumors in infancy and childhood. Cardiology, 67:12-22, 1991.
29. SOUZA, D. R. S. & GRECO, O. T. - Tumores cardiacos. Rev. Soc. Cardiol. E.S.P., 1:59-64, 1992.
30. STOUT, A. P. & LATTERS, R. - Tumors of the soft tissues. In: Atlas of tumor pathology. Washington D.C., Armed Forces Institute of Pathology, 1967. Fascículo 1, serie 2, p. 35-37.
31. STRAUS, R. & MERLISS, R. - Primary tumor of the heart. Arch. Pathol., 39:74-78, 1945.
32. TILLMANNS, H. - Clinical aspects of cardiac tumors. Thorac. Cardiovasc. Surg., 38 (Supl. 2):152-156, 1990. [MedLine]
33. VAN GELDER, M. H.; O'BRIEN, J. D.; STAPLES, D. E.; ALEXANDER, J. A. - Familial cardiac mixoma. Ann. Thorac. Surg., 53:419-424, 1992. [MedLine]
34. WEINLERY, B. A.; CACES Jr., D. J.; WALLER, B. F. - Cardiac manifestations of no-cardiac tumors. I: Direct effects. Clin. Cardiol., 12:289-296, 1989. [MedLine]
35. WILLIAMS, D. B., DANIELSON, G. K.; McGOON, D. C.; FELDT, R. H.; EDWARDS, W. D. - Cardiac fibromas: long-term survival after excision. J. Thorac. Cardiovasc. Surg., 84:230-236, 1982. [MedLine]
36. YAMAGUCHI, M.; HOSOKAWA, Y.; MINAMIJI, K. - Cardiac fibroma. J. Thorac. Cardiovasc. Surg., 103:140-145, 1992. [MedLine]