Tumors of the Right Atrium – A Review of cases operated in Department of Cardiac Surgery, Medical University of Lodz, between 2008 and 2015
Abstract
Cardiac tumors, especially those of the right atrium (RA), are not prevalent. The most common tumor of RA is myxoma which must be differentiated with other neoplastic tumors and thrombi. The most important role in diagnostics plays echocardiography and histopathological examination of removed masses. Other diagnostic methods also deliver additional information useful in therapeutic process. Nine cases of tumors of RA operated through median sternotomy both electively and non-electively, between 2008 and 2015, were analyzed in the present study. The rate of myxomae and thrombi was higher than expected. Also operative outcome was found to be worse in non-elective patients. Although due to a small number of analyzed patients, further studies including multicenter trials are necessary. The fact that fast diagnostics enabling optimal timing and type of the surgery is essential for good therapeutic results is undeniable. One of the reasons which may delay a proper diagnosis is the fact that tumors of RA do not have specific clinical presentation and are quite rare.
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Introduction
Background Primary cardiac tumors are uncommon. They were found in 0,001-0,03% cases on autopsy. Lately, their prevalence is estimated for ca 0,02% [1,2,3,4,5,6]. On histopathological examination, cardiac tumors in 75% are benign lesions and 50% has a structure of myxoma [2,3]. In differential diagnostics primary malignancies, metastases and organized thrombi must be considered [12,19]. Myxoma which is most prevalent tumor usually is localized in the left atrium (75%) or RA (18%). Ventricular localization of myxoma is quite rare [2]. It is more common in women. The most important imaging technique in diagnostics of cardiac tumors is echocardiography, both transthoracic (TTE) and transesophageal (TEE). Magnetic resonance (MR) and positron emission tomography (PET) are also very valuable diagnostic methods because they have high specificity and sensitivity. Coronary angiography is also of large clinical importance providing some data on tumor’s vascularization. On the basis of above mentioned imaging methods it is possible to state preliminary diagnosis of cardiac tumor including anatomical relations. Ultimate diagnosis is possible only on the basis of histopathological examination of a specimen of operatively removed lesion [13].
Conclusion
1. Although possible, concluding on the basis of such a small patients’ group allows only for signaling a scale of the problems connected with diagnosing and operating the right atrium tumors. However, further multicenter analysis would be of a greater clinical significance.
2. The proper and quick diagnostics is essential for an increase of surgical treatment effectiveness. The fact that urgent operations have much worse outcomes should be especially emphasized.
3. The classical operation through median sternotomy remains predominant therapy in the right atrium tumors. However, in the future the increase of less-invasive methods can be expected, especially in patients with much co-morbidity not requiring additional simultaneous cardiac procedures.
4. Echocardiography is the most important method in proper qualification to the surgery of the right atrium tumors. However, other imaging techniques such as CT, MRI or PET may be very helpful in more accurate diagnostics of the tumor and detecting of other potential foci.