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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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01. History of Cardiology
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
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26. Cardiovascular Surgery
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28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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34. Public Health and Health Economics
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Cardiac tumours: three decades of experience from a tertiary cardiac surgery centre
Session:
Posters 4 - Écran 4 - Doenças do Miocárdio
Speaker:
Gustavo Sá Mendes
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
19. Tumors of the Heart
Subtheme:
19.2 Tumors of the Heart – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Gustavo Sá Mendes; João Abecasis; António Miguel Ferreira; Regina Ribeiras; Tiago Nolasco; Eduarda Horta; Miguel Abecasis; Rosa Gouveia; Miguel Mendes; Sância Ramos; José Pedro Neves
Abstract
<p>Cardiac tumours are relatively rare and non-invasive diagnosis remains challenging despite improvements provided by newer imaging tools. Our aim was to describe the experience of a cardiac surgery centre managing cardiac tumours.</p> <p><strong>Methods:</strong> Single-centre retrospective study of consecutive patients admitted to a tertiary centre with the diagnosis of a cardiac mass or tumour between 1990 and 2018. Registry data concerning clinical presentation, non-invasive assessment, presumptive diagnosis, treatment strategy and histopathology were collected. The follow-up was obtained either from clinical records or telephone contact.</p> <p><strong>Results:</strong> We included 154 patients (pts), 95 (61,7%) females, with a median age of 61 [51-71] years. Pathologic diagnosis was made in 144 pts: 117 (81%) benign lesions (106 myxomas; 11 papillary fibroelastomas); 8 (6%) primary tumours (3 lymphomas, 2 fibrous histiocytomas, 2 rhabdomyosarcomas and 1 myxofibrosarcoma) and 3 (2%) secondary malignancies (1 renal cell carcinoma extension; 2 metastatic invasions from malignant melanoma and ovary tumour). 16 (11%) of lesions were identified as pseudotumours. There were 3 cases of insufficient material for diagnosis and in 7 pts it was not accomplished surgical excision (4 asymptomatic tricuspid valve fibroelastomas; 2 pts refusing intervention; 1 pts referred for chemotherapy). Pts with benign tumours were older than those with malignant lesions (62 versus 48y) with female predominance (65% versus 27%, p=0,021). </p> <p>Overall, 36% of pts with benign tumours were asymptomatic, being symptomatic all malignant lesion pts. The majority (86%) of benign tumours were localized in the left atrium, different from malignant tumours that were mainly seen in the right heart (64%). 83% of the tumours were first detected by transthoracic echocardiography. Computed tomography and cardiac magnetic resonance were performed in 14% of the cases. Pre-operative presumptive diagnosis was correct in 79% of the benign cases, being wrong in 55% of malignant lesions (previously considered as benign).</p> <p>During the follow-up period of 10,5 ± 12,2 years there were 12 (7.8%) recurrences (only 3 benign tumours). Direct tumour associated mortality occurred in 11 patients (7.1%), 3 of them from benign conditions. </p> <p><strong>Conclusion:</strong> Benign tumours are far more common than both primary and secondary cardiac malignancies. In this series, adjunctive non-invasive imaging investigation beyond echocardiography was used in a small number of cases. As presumptive diagnosis before surgical mass excision is mostly wrong in identifying malignant lesions, preoperative non-invasive investigation should be expanded when trying to define the best therapeutic approach. </p>
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