Rezidenti Tumorile Cardiace PDF

Tumorile cardiace
© Toate drepturile rezervate dr. Antoniu Petris
Antoniu Petris MD,

MD, PhD,
PhD, FESC
FESC
“St.
“St. Spiridon”
Spiridon” Hospital
Hospital Iasi,
Iasi, Romania
Romania
“Grigore
“Grigore T.
T. Popa”
Popa” UMF
UMF Iasi,
Iasi, Romania
Romania
Primary tumors of the heart are rare across all age groups, with a reported
prevalence of 0.001% to 0.03% in autopsy series.
Secondary involvement of the heart by extracardiac tumors is 20 to 40

times more common than by primary cardiac tumors.
In the fetus, there is a higher proportion of germ cell tumors.
About 75% of all primary cardiac tumors are regarded as benign

neoplasms and cardiac myxoma accounts for at least half of them.
Of the remaining 25% (malignant neoplasms) the majority are

sarcomas; lymphomas are the next most common.
Extra-cardiac tumors can involve the heart by direct invasion from
adjacent malignancies (lung, breast), by lymphatic spread, or by
metastatic spread of distant disease (lymphoma, melanoma).
Nonprimary cardiac tumors can affect the heart by:

- Invasion of the pericardium, epicardium, myocardium, or endocardium
- Production of biologically active substances
- Toxic effects of treatment on the heart (e.g., radiation or chemo-
therapy)
Myocardial involvement by metastatic disease is less common than

pericardial involvement, but does occur, particularly with lymphoma

or melanoma.
Intramyocardial masses can project into or compress cardiac

chambers, resulting in hemodynamic compromise.
Endocardial involvement is rarely seen.

PAPILLARY TUMORS OF HEART VALVES - Papillary fibroelastoma is the third most

common primary cardiac tumor INCIDENCE 0.33%
The clinical manifestations can be divided into four
general mechanistic categories:
1. Systemic manifestations
2. Cardiac manifestations
3. Embolic manifestations
4. Phenomena secondary to metastatic diseases
CARDIAC MANIFESTATIONS
Mechanisms © Toate drepturile rezervate dr. Antoniu Petris
1. Direct mechanical interference with myocardial or valvular

function
2. Interruption of coronary blood flow
3. Interference with electrophysiologic conduction
4. Accumulation of pericardial fluid.
SYSTEMIC MANIFESTATIONS
 Constitutional symptoms of fever, chills, fatigue, malaise,
and weight loss.
 In addition, myalgia, arthralgia, muscle weakness, and

Raynaud phenomenon.
 Routine laboratory tests may reveal leukocytosis,

polycythemia, anemia, thrombocytosis, thrombocytopenia,
hypergammaglobulinemia, and increased ESR.
 These systemic manifestations are believed to be

produced by secretory products released by the tumor or by
tumor necrosis.
Most commonly seen in : cardiac myxoma

Caused by : increased Serum IL-6 levels.
Carney syndrome accounts for the majority of familial cases of cardiac
myxoma and for 7% of all cardiac myxomas
Carney syndrome show no age or gender predilection, can be single or multiple, can
occur in any intracardiac location, and tend to recur with a rate of 20% despite adequate
surgical excision.
EMBOLIC PHENOMENON
Systemic or pulmonary embolism via tumor emboli or
thromboemboli from or formed on the surface of the tumor,
respectively.
The propensity to embolize depends on the origin of the tumor

(intramural or intracavitary), the type of the tumor, and the friability
of the intraluminal tumor surface.

Physical examination
may reveal signs of pulmonary congestion with
• an S3 and loud and widely split S1,
• a holosystolic murmur most prominent at the apex with
radiation to the axilla,
• a diastolic murmur from turbulent blood flow through the mitral
orifice, and a tumor “plop.”
The ultrafast computed tomographic and echo studies show the

tumor obstructing the mitral orifice with a piston-like action, first
pushing a bolus of blood into the ventricle and then coming to

rest in the mitral orifice.
This sudden bolus of blood plus tumor in the ventricle causes a
third sound, called a "tumor plop" while relieving the left
atrium of that volume and causing an abrupt y-descent in the
left atrial pressure. Sound is evanescent and positional It
occurs later than an OS but earlier than an S3.
For intracavitary tumors located in the RA, findings of right-sided
heart failure that include fatigue, peripheral edema,
ascites,hepatosplenomegaly, and elevated JVP with a prominent a
wave are the most common cardiac presentations.
Because of the RA location, the diagnosis is often delayed, with

an average time interval from presentation to the correct diagnosis of
3 years. Patients frequently present with rapidly progressive right-
sided heart failure and also new-onset heart murmurs because of
mechanical interference with the tricuspid valve.
In patients with a PFO, the buildup of RA pressure can produce

right-to-left intracardiac shunting with resulting systemic hypoxia,
cyanosis, clubbing, and polycythemia.
On occasion, patients may also present with superior vena cava

syndrome caused by a large right atrial tumor.
https://www.semanticscholar.org/paper/Anesthetic-Implications-of-Superior-Vena-Cava-in-A-
Dishman/049c6bcc79e53483a8312e2e944cc916485b9696
LV tumors can obstruct the LVOT and produce findings of
left-sided heart failure and syncope as well as atypical chest
pain from obstruction of a coronary artery by either direct
tumor involvement or tumor emboli.
Physical examination may reveal evidence of pulmonary

edema, low blood pressure, and systolic murmurs that
mimic the findings of aortic or subaortic stenosis.
The murmurs and blood pressure may display considerable

positional variation.
- In the case of malignant primary cardiac tumors, such as
angiosarcomas and primary cardiac lymphomas, malignant
hemorrhagic pericardial effusion may be present.
- Life-threatening cardiac tamponade and cardiac rupture
leading to sudden death may also occur
Mixom
AS
RHABDOMYOMA
Most frequent PCT in infants an

children.
80% in <1 year but adult presentatio
also seen while rare.
Arrhythmias represent the mos
common presentation in adults
70% atrial origin and 30% ventricular
No recurrence.
Prognosis of this disease is excellent
DIFFIRENTIAL DIAGNOSIS OF MASS

Radiology: Volume 268: Number 1—July 2013 n radiology.rsna.org


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Tumorile cardiace

© Toate drepturile rezervate dr. Antoniu Petris

Antoniu Petris MD,

Secondary involvement of the heart by extracardiac tumors is 20 to 40

In the fetus, there is a higher proportion of germ cell tumors.

About 75% of all primary cardiac tumors are regarded as benign

Of the remaining 25% (malignant neoplasms) the majority are

Nonprimary cardiac tumors can affect the heart by:

Myocardial involvement by metastatic disease is less common than

pericardial involvement, but does occur, particularly with lymphoma

Intramyocardial masses can project into or compress cardiac

Endocardial involvement is rarely seen.

PAPILLARY TUMORS OF HEART VALVES - Papillary fibroelastoma is the third most

1. Direct mechanical interference with myocardial or valvular

 In addition, myalgia, arthralgia, muscle weakness, and

 Routine laboratory tests may reveal leukocytosis,

 These systemic manifestations are believed to be

Most commonly seen in : cardiac myxoma

© Toate drepturile rezervate dr. Antoniu Petris

The propensity to embolize depends on the origin of the tumor

© Toate drepturile rezervate dr. Antoniu Petris

The ultrafast computed tomographic and echo studies show the

pushing a bolus of blood into the ventricle and then coming to

Because of the RA location, the diagnosis is often delayed, with

In patients with a PFO, the buildup of RA pressure can produce

On occasion, patients may also present with superior vena cava

Physical examination may reveal evidence of pulmonary

The murmurs and blood pressure may display considerable

Most frequent PCT in infants an

© Toate drepturile rezervate dr. Antoniu Petris

Radiology: Volume 268: Number 1—July 2013 n radiology.rsna.org

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