Cardiac Tumours
  • Cardiac tumours are rare.
  • They are most often from  metastatic disease, but primary cardiac tumours can occur.
  • Approximately 75% of primary cardiac tumours are benign the vast majority of these being  atrial myxomas.
  • Malignant tumours are usually sarcomas.
  • Clinically presentation can vary from asymptomatic to life-threatening complications such as valve obstruction, embolism, or arrhythmia.

Benign Tumours

Atrial Myxoma

  • Most common cardiac tumour identified.
  • More commonly diagnosed in women in the 5th to 7th decade of life.
  • Usually identified in the left atrium (80-90%), they have a stalk, and are often attached the interatrial septum.
  • Patients may have tumour embolus, functional mitral stenosis from obstructing tumour, or constitutional symptoms.
  • Atrial myxoma’s can be familial and family screening should be considered. “Carney Complex” autosomal dominant disease associated with multiple cardiac tumours and extra cardiac myxoma’s.
  • Treatment involves surgical resection.
  • They can reoccur and frequent screening with a transthoracic echo should be done post resection.

Papillary Fibroelastoma

  • Small tumours that adhere to the valves.
  • Most commonly effect the aortic valve.
  • They are usually solitary lesions that often resemble a “Sea Anemone”
  •  Can be mistaken for valvular vegetations.
  • Though previously though to be of little conciquence they are associated with thromboembolism.
  • Surgical resection is generally indicated if greater than 1 cm or embolism or highly mobile.

Rhabdomyoma

  • Most common cardiac tumour in children.
  • Usually multiple tumours in the ventricle can be associated with outflow tract obstruction.
  • Associated with tuberous Sclerosis

Lipoma

  • Usually subendocardial or subpericardial.
  •  Can be associated with arrythmias or AV block
  • MRI can be helpful at characterizing the lipoma.

Primary Malignant Tumours

Angiosarcoma

  • Most commonly seen in men.
  • Usually found in the right atrium usually beside the IVC.
  • Frequently metastatic disease found at time of the diagnosis.
  • Very poor prognosis, survival often less than a year.

Rhabdomyosarcoma

  • Commonly seen in children and young adults.
  • Often have multiple lesions with may involve any chamber.
  • Very poor prognosis with survival less than a year.

Leiomyosarcoma

  • Commonly seen in the left Atrium.
  • Usually solitary lesion.
  • Mean survival 6 months.

Cardiac Lymphoma

  • Commonly seen in the right heart.
  • Usually solitary.
  • Often associated with pericardial effusion.
  • Frequently have extracardiac manifestations. 

Secondary Tumours

  • Metastatic cancers are exceptionally more common than primary malignant tumours.
  • Carcinoma of the breast and lung can have local invasion.
  • Renal cell cancers and invade up the inferior vena cava.
  • Melanomas often have a predilection for metastasizing to the heart.

References

Shapiro LM Cardiac tumours: diagnosis and management Heart 2001;85:218-222.