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Surgical treatment of primary cardiac valve tumor: early and late results in eight patients.

Wang Y, Wang X, Xiao Y - J Cardiothorac Surg (2016)

Bottom Line: The intraoperative frozen sections and postoperative pathology analysis provided accurate diagnosis and supported the treatment strategies.Early diagnosis and intervention were keys to reserve the normal original valve function.Prompt surgical resection is necessary to prevent potential critical events.

View Article: PubMed Central - PubMed

Affiliation: Institute of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, No. 183 Xinqiao Rd, Shapingba, Chongqing, 400037, China. wy003236@hotmail.com.

ABSTRACT

Background: To report early and late outcomes of patients with the primary cardiac valve tumor undergoing surgical treatment over a 30-year period in our cardiovascular center.

Methods: From January 1980 to December 2014, a total of 211 patients with primary cardiac tumors accepted surgical treatments, of which only 8 (3.8 %) were primary cardiac valve tumor patients in our surgical center of cardiovascular.

Results: The diagnosis was identified by echocardiography preoperatively and pathological analysis postoperatively. All patients underwent intracardiac procedures with extracorporeal circulation. Intracardiac procedures included resection of tumor on leaflet in 2 patients (25 %), resection of tumor and native valvuloplasty in 2 patients (25 %), resection of neoplasm and replacement of native valve with prosthetic valve in 4 patients (50 %). One man was performed a resection of tumor on aortic noncoronary leaflet and a coronary artery bypass graft. Eight cases of primary valve tumor occurred in all of four cardiac valves. The majority of valvular tumor was myxoma in 3 cases (37.5 %), followed by the papillary fibroelastomas in 2 cases (25 %). There were one rhabdomyoma (12.5 %), one lipoma (12.5 %) and one mild malignant sarcoma (12.5 %). The mitral valve was the most commonly original valve (62.5 %). There was pulmonic (12.5 %), aortic (12.5 %) and tricuspid (12.5 %) valve tumor each one patient. There was no death and recrudescence in the series. Follow-up of all patients ranged from 1 to 16 years (mean 7.06 ± 4.24 years). There was no recrudesce and cardiac valve dysfunction.

Conclusion: The incidence of primary valve tumor was very low. More understanding of the rare disease and widespread use of echocardiography would greatly improve the diagnosis of primary valve tumor in the early stage. Echocardiography could detect millimeters in diameter neoplasms on cardiac valve. The diagnoses were based on imaging findings and the classical triad symptoms associated with the hemodynamic abnormalities, the organ embolism and the systemic symptoms directly from tumors. The intraoperative frozen sections and postoperative pathology analysis provided accurate diagnosis and supported the treatment strategies. Early diagnosis and intervention were keys to reserve the normal original valve function. Prompt surgical resection is necessary to prevent potential critical events.

No MeSH data available.


Related in: MedlinePlus

(Case 4, Mitral valve rhabdomyoma) a: A light-red elliptical neoplasm with smooth surface, shaved completely from the mitral anterior leaflet, 1 × 0.8 × 0.4 cm3. b: Histologically, the tumor was highly cellular and composed of somewhat pleomorphic, polygonal muscle cells admixed with spindle-shaped cells. There was “spider web” appearance in some tumor cells which has been known as the classic microscopic finding for rhabdomyoma. The tumor showed widely myxoid degeneration. (Hematoxylin and eosin)
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Fig1: (Case 4, Mitral valve rhabdomyoma) a: A light-red elliptical neoplasm with smooth surface, shaved completely from the mitral anterior leaflet, 1 × 0.8 × 0.4 cm3. b: Histologically, the tumor was highly cellular and composed of somewhat pleomorphic, polygonal muscle cells admixed with spindle-shaped cells. There was “spider web” appearance in some tumor cells which has been known as the classic microscopic finding for rhabdomyoma. The tumor showed widely myxoid degeneration. (Hematoxylin and eosin)

Mentions: The eight patients were performed with intravenous combined anesthesia, endotracheal intubation, a median sternotomy, and general establishment of extracorporeal circulation with moderate hypothermia (nasopharyngeal temperature 26 to 30 °C). The myocardial protection was provided by delivering intermittent antegrade cold blood cardioplegia. Time of cardiopulmonary bypass was 74.38 ± 20.74 (45–102) minutes; the cross-clamping aorta was 56.13 ± 18.87 (32–86) minutes. Case 1 and 3 were performed excision of the tumor on the anterior mitral leaflet and on the tricuspid septal leaflet respectively. Case 2 with a neoplasm on the aortic noncoronary leaflet and a coronary artery disease was performed excision the tumor and coronary artery bypass grafting for the left anterior descending artery at the same time. Patient 4 (Fig. 1), a 1-year-old boy, underwent an excision of a neoplasm on anterior commissure of mitral valve. Patient 5 (Fig. 2) and 7 (Fig. 3) were both performed excision of tumor and native mitral leaflet, replaced with a mechanical mitral valve. Patient 6 (Fig. 4), a 26-year-old lady who wanted to breed, underwent an excision of a tumor on the mitral valve and replacement with a bioprothetic valve. Patient 8 (Fig. 5) with a giant tumor on the right ventricular outflow tract was performed excision of neoplasm and destroyed native pulmonary valve, replaced with a bioprothetic valve. Intraoperative transesophageal echocardiography confirmed without original valvular regurgitation and prosthetic valve dysfunction. We used intraoperative frozen sections (4/8 cases, 50 %) and neoplasm appearance to decide our surgical strategies. Pathologic analysis confirmed the accurate diagnosis. The only malignant patient (Fig. 2), case 5, had underwent intravenous systemic chemotherapy for three cycles within 6 months postoperatively. The detailed clinical data and pathological findings are showed in Table 1.Fig. 1


Surgical treatment of primary cardiac valve tumor: early and late results in eight patients.

Wang Y, Wang X, Xiao Y - J Cardiothorac Surg (2016)

(Case 4, Mitral valve rhabdomyoma) a: A light-red elliptical neoplasm with smooth surface, shaved completely from the mitral anterior leaflet, 1 × 0.8 × 0.4 cm3. b: Histologically, the tumor was highly cellular and composed of somewhat pleomorphic, polygonal muscle cells admixed with spindle-shaped cells. There was “spider web” appearance in some tumor cells which has been known as the classic microscopic finding for rhabdomyoma. The tumor showed widely myxoid degeneration. (Hematoxylin and eosin)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4759914&req=5

Fig1: (Case 4, Mitral valve rhabdomyoma) a: A light-red elliptical neoplasm with smooth surface, shaved completely from the mitral anterior leaflet, 1 × 0.8 × 0.4 cm3. b: Histologically, the tumor was highly cellular and composed of somewhat pleomorphic, polygonal muscle cells admixed with spindle-shaped cells. There was “spider web” appearance in some tumor cells which has been known as the classic microscopic finding for rhabdomyoma. The tumor showed widely myxoid degeneration. (Hematoxylin and eosin)
Mentions: The eight patients were performed with intravenous combined anesthesia, endotracheal intubation, a median sternotomy, and general establishment of extracorporeal circulation with moderate hypothermia (nasopharyngeal temperature 26 to 30 °C). The myocardial protection was provided by delivering intermittent antegrade cold blood cardioplegia. Time of cardiopulmonary bypass was 74.38 ± 20.74 (45–102) minutes; the cross-clamping aorta was 56.13 ± 18.87 (32–86) minutes. Case 1 and 3 were performed excision of the tumor on the anterior mitral leaflet and on the tricuspid septal leaflet respectively. Case 2 with a neoplasm on the aortic noncoronary leaflet and a coronary artery disease was performed excision the tumor and coronary artery bypass grafting for the left anterior descending artery at the same time. Patient 4 (Fig. 1), a 1-year-old boy, underwent an excision of a neoplasm on anterior commissure of mitral valve. Patient 5 (Fig. 2) and 7 (Fig. 3) were both performed excision of tumor and native mitral leaflet, replaced with a mechanical mitral valve. Patient 6 (Fig. 4), a 26-year-old lady who wanted to breed, underwent an excision of a tumor on the mitral valve and replacement with a bioprothetic valve. Patient 8 (Fig. 5) with a giant tumor on the right ventricular outflow tract was performed excision of neoplasm and destroyed native pulmonary valve, replaced with a bioprothetic valve. Intraoperative transesophageal echocardiography confirmed without original valvular regurgitation and prosthetic valve dysfunction. We used intraoperative frozen sections (4/8 cases, 50 %) and neoplasm appearance to decide our surgical strategies. Pathologic analysis confirmed the accurate diagnosis. The only malignant patient (Fig. 2), case 5, had underwent intravenous systemic chemotherapy for three cycles within 6 months postoperatively. The detailed clinical data and pathological findings are showed in Table 1.Fig. 1

Bottom Line: The intraoperative frozen sections and postoperative pathology analysis provided accurate diagnosis and supported the treatment strategies.Early diagnosis and intervention were keys to reserve the normal original valve function.Prompt surgical resection is necessary to prevent potential critical events.

View Article: PubMed Central - PubMed

Affiliation: Institute of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, No. 183 Xinqiao Rd, Shapingba, Chongqing, 400037, China. wy003236@hotmail.com.

ABSTRACT

Background: To report early and late outcomes of patients with the primary cardiac valve tumor undergoing surgical treatment over a 30-year period in our cardiovascular center.

Methods: From January 1980 to December 2014, a total of 211 patients with primary cardiac tumors accepted surgical treatments, of which only 8 (3.8 %) were primary cardiac valve tumor patients in our surgical center of cardiovascular.

Results: The diagnosis was identified by echocardiography preoperatively and pathological analysis postoperatively. All patients underwent intracardiac procedures with extracorporeal circulation. Intracardiac procedures included resection of tumor on leaflet in 2 patients (25 %), resection of tumor and native valvuloplasty in 2 patients (25 %), resection of neoplasm and replacement of native valve with prosthetic valve in 4 patients (50 %). One man was performed a resection of tumor on aortic noncoronary leaflet and a coronary artery bypass graft. Eight cases of primary valve tumor occurred in all of four cardiac valves. The majority of valvular tumor was myxoma in 3 cases (37.5 %), followed by the papillary fibroelastomas in 2 cases (25 %). There were one rhabdomyoma (12.5 %), one lipoma (12.5 %) and one mild malignant sarcoma (12.5 %). The mitral valve was the most commonly original valve (62.5 %). There was pulmonic (12.5 %), aortic (12.5 %) and tricuspid (12.5 %) valve tumor each one patient. There was no death and recrudescence in the series. Follow-up of all patients ranged from 1 to 16 years (mean 7.06 ± 4.24 years). There was no recrudesce and cardiac valve dysfunction.

Conclusion: The incidence of primary valve tumor was very low. More understanding of the rare disease and widespread use of echocardiography would greatly improve the diagnosis of primary valve tumor in the early stage. Echocardiography could detect millimeters in diameter neoplasms on cardiac valve. The diagnoses were based on imaging findings and the classical triad symptoms associated with the hemodynamic abnormalities, the organ embolism and the systemic symptoms directly from tumors. The intraoperative frozen sections and postoperative pathology analysis provided accurate diagnosis and supported the treatment strategies. Early diagnosis and intervention were keys to reserve the normal original valve function. Prompt surgical resection is necessary to prevent potential critical events.

No MeSH data available.


Related in: MedlinePlus