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A. Basics
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
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13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
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19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
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Primary and secondary malignant cardiac tumors – a 22 year case review
Session:
Painel 10 - Doença Valvular 4
Speaker:
Pedro Brás
Congress:
CPC 2020
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:
Pedro Garcia Brás; Luisa Moura Branco; Alexandra Castelo; Vera Ferreira; José Miguel Viegas; Tânia Branco Mano; Ana Galrinho; Ana Teresa Timóteo; Joao Abreu; Eugénia Pinto; Pedro Coelho; Ivan Bravio; Rui Cruz Ferreira
Abstract
<p>Background: Primary cardiac tumors are extremely rare and are usually diagnosed late due to the non-specific symptomatology. Surgery is the main treatment option, and despite chemotherapy, the prognosis remains poor. Cardiac invasion by metastatic tumors, while more common, also entails an unsatisfactory outcome.</p> <p>Purpose: To review patients (P) with malignant cardiac tumors that were diagnosed by transthoracic echocardiogram (TTE) or transesophageal echocardiogram (TEE) in a tertiary center between 1997 and 2019.</p> <p>Methods: Retrospective analysis of clinical data from the digital files, echocardiographic assessment of tumor location and morphology, histology results and survival outcomes.</p> <p>Results: A total of 33 malignant cardiac tumors were diagnosed: 12 primary tumors (A) and 21 metastatic tumors (B).</p> <p>A: Regarding primary cardiac tumors, the most common types were angiosarcomas (6 cases), 2 undifferentiated pleomorphic sarcomas, 2 fibrosarcomas, 1 myxofibrosarcoma and 1 primary cardiac lymphoma.</p> <p>The mean age of P at time of diagnosis was 43±15 years, 50% female gender. The most frequent presentation was heart failure symptoms (50% of P) followed by arrhythmias (20%). One patient had a rare presentation with pruritus and polyarthralgias.</p> <p>On TTE, the most prevalent tumor location was in the right-heart chambers (70%) – mostly the right atrium (50%), with mean dimensions of 40±18 x 27±11 mm. 85% of patients had preserved systolic left ventricular function and there was moderate or severe pericardial effusion in 38%.</p> <p>The most frequent metastatic involvement of primary tumors at diagnosis was pulmonary (33%) and hepatic (33%).</p> <p>50% of P were submitted to tumor resection and 40% were submitted to chemotherapy.</p> <p>In the case of angiosarcomas, the most common immunohistochemical markers were vimentin, CD31 and CD34.</p> <p>The authors found a mortality rate of 81% in P with primary cardiac tumors, with a median time of follow-up of 6 months (minimum of 20 days and maximum of 18 years). In the latter case, the P was submitted to heart transplantation after diagnosis of a fibrosarcoma and is still alive and well.</p> <p>B: Regarding secondary cardiac invasion, there was a diagnosis of the following primary tumor sites: 6 thymomas, 4 cases of lymphoma, 3 lung carcinomas, 3 hepatocellular carcinomas, 2 bladder carcinomas, 1 parathyroid carcinoma, 1 soft tissue sarcoma and 1 melanoma.</p> <p>The mean age of P with metastatic involvement of the heart was 57±22 years, 65% male. On TTE/TEE the authors also found a right-sided chambers predominance (60%), with pericardial metastasis in 35%.</p> <p>As expected, the mortality rate was also extremely high (90%), with a median time of follow-up of 1.5 months (minimum of 1 week, maximum of 44 months).</p> <p>Conclusion: Cardiac malignant tumors generally present in a late stage with a dismal prognosis. When possible, heart transplantation can be an option with a good outcome.</p>
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