Primary cardiac tumors: experience with 25 cases.

The case histories of patients with primary cardiac neoplasms are presented. The mean age was 49.6 years and females predominated (17:8). Nineteen of the tumors were benign (76%), 18 myxomas and one mesenchymal hamartoma. There were six malignant neoplasms; two myxosarcomas, two rhabdomyosarcomas, one skeletal angiomatosis, and one malignant melanoma. The clinical presentation was congestive heart failure in 17 patients and peripheral embolization in five (one patient with both). There were four asymptomatic patients. Antemortem diagnosis was made in 20 patients and five were discovered at autopsy. After 1970, almost 95% of the patients were diagnosed preoperatively while only 14% of the patients had preoperative diagnosis before 1970. Cardiac catheterization and echocardiography were the most useful diagnostic procedures performed but a computed tomographic scan of the heart performed in a patient with right ventricular hamartoma was of great value in delineating the lesion. Twenty-one patients underwent a total of 26 operations but complete excision of the lesion was possible in only 16 patients. Three patients underwent extensive resection and reconstruction. Associated procedures consisted of coronary artery bypass grafts in two patients, mitral valve annuloplasty in one, and a right lung biopsy. Although there was no operative mortality following the original procedure, one patient died after a third operation for recurrence and another underwent unsuccessful emergency pericardiectomy. All patients with malignant lesions died from recurrence 6 to 13 months postoperatively while only three patients in the benign group died and these of unrelated causes. Surgical resection is the treatment of choice for all primary cardiac neoplasms since it is curative in the benign tumors and may prolong life for up to a year with malignant tumors.