Vol. 20 JA2016 - cardiac

C-06 – Surgery of cardiac tumors: about 100 patients

novembre 29, 2016
Auteur correspondant : Redha Lakehal

Redha Lakehal, Radouane Boukaroucha, Farid Aimar, Rabeh Bouharraga, Radouane Bellara, Rafik Nazzel, Fateh Guériti, Amine Amros, Rabeh Daoud, Samiha Chérif, Nadjet Massikh, Baya Aziza, Soumaia Bendjaballah, Abdelmalek Brahami

Institution : Service de chirurgie cardiaque, EHS Djeghri-Mokhtar (ex Erriadh), Constantine, Algérie

Objectives : Cases of cardiac tumors including primitives described in the literature remains infrequent compared to metastatic one (secondary tumors). Frequency: 0.001% and 0.28%. The diagnosis become increasingly early by dint of modern imaging advent, which facilitated curative surgery and a better prognosis particularly for benign tumors. The Aim of the study: Bring the experience of our service center in the management of cardiac tumors, their clinical presentation, treatment modalities, morbidity and mortality and recurrences frequency.

Methods : During the period between January 2000 to December 2015: 100 patients underwent open heart surgery for cardiac tumor (35 men and 65 women). The average age: 48.79 years with extremes (5-77 years). The symptomatologyis dominated by dyspnea (71% are patients with stage II-III NYHA), palpitations, fainting/syncope, or embolic complications. The transthoracic echocardiographic confirms the diagnosis in all cases. In some cases: a chestCT.

Results : Surgical excision with cardiopulmonary bypass (CPB) in 12 patients (without clamping). Surgical expertise specified the type-nature of the tumor: 92% of benign tumors (70% are myxomas). The preferred seat is the left atrium (67 patients). The pathological forms are 1 polymorphic poorly differentiated sarcoma; 2 fibrosarcoma; 1 embryonal rhabdomyosarcoma (girl of 5 years); 1 Kaposi; 1 angiosarcoma, 2 non Hodgkin’s lymphoma.

Total operative mortality: 6% (6 patients). Immediate complications: conduction disorder in 2 patients. The average follow up is between 1 month to 7 years. Late deaths (3%) due to extra cardiac causes. 3 recurrences: 2 for myxoma, 1 for fibrosarcoma. By cons there was a very good evolution in the patient with non Hodgkin’s lymphoma.

Conclusion : Thanks to modern imaging advent, diagnosis can be early before the onset of serious complications; if only one clinically suspicious. The prognosis of benign cardiac tumors depends on the quality of surgical treatment. Surgery gives very good immediate and remote insisting on a periodic and regular monitoring; by cons for malignant tumors, it remains worse and depends on early in the surgical management, which is not hollowing since become symptomatic tumors are not at an advanced stage, in addition requires good protocols codified for these very rare and also very serious tumors.