Primary Cardiac Tumors Operated on in Côte d’Ivoire: They Are Almost All Myxomas

Objective: Through this surgical series, we present the epidemiological and anatomical-clinical aspects and the surgical results concerning patients operated on for a primary cardiac tumor at the Abidjan Heart Institute. Materials and Method: This is a retrospective descriptive study covering the period of January 1982 to December 2022, based on the medical records of patients operated on for a primary cardiac tumor at the Abidjan Heart Institute. Results: Twenty-seven (27) patients underwent surgery for a primary cardiac tumor, including 14 women and 13 men with a mean age of 41.5 years (range 19 - 76 years). The main circumstances of discovery were exertional dyspnea, palpitation and syncope or pseudo-syncope. The main site was the septal wall of the left atrium. The diagnosis of myxoma was confirmed by pathological examination of the surgical specimen in 96.3% (n = 24) of the patients and it was a malignant large cell immunoblastic lymphoma of the myocardium in 3.7% (n = 1) of the patients. The mean largest diameter was 46.1 mm. The postoperative course was marked by an ischaemic stroke (n = 1);recurrence of a left atrial myxoma 5 years after the first tumor removal (n = 1). Two cases of death were noted, one due to the evolution of immunoblastic large cell lymphoma and the other due to an extracorporeal circulation accident. Conclusion: Almost all primary cardiac tumors operated on in Abidjan are myxomas. The circumstances of the discovery of these cardiac tumors are multiple and varied but dominated by exertional dyspnea, palpitation and syncope. Whatever their histological type, primary cardiac tumors are serious affections, in view of the haemodynamic and rhythmic disorders they cause.

THE CLINICOPATHOLOGICAL AND PROGNOSTIC STUDY ON 42 CASES WITH CARDIAC TUMOR

Objective: To analyze the relation between the pathological changes and the clinical manifestations and the prognosis of cardiac tumors through the pathological study on 42 cases with cardiac tumor, in order to improve the knowledge of the tumors, to make early diagnosis and to raise the curative ratio.Materials and Methods: 42 confirmed cardiac tumors of our department were selected, among whick 41was surgical specimen and 1 was autopsy. The study was Pcrformed by using the common and special histochemical staining.Results: 41 is Primary and 1 is secondary which is a metastazed hepatocelular carcinoma. In the Primary ones,39 (95.1%) is benign, including myxoma, fibroma,rhabdomyoma and Pericardial cyst, while 2 (4. 9%) is malignant, including neuroleminafibrosarcoma and malignant mesothelioma. In the myxomas, female patients occupy 75%, 91.7% exists in the left atrium and every one has got a peduncle adbesive to the fossa ovalis or adjacency of the atrial septum.Conclusions: The results of the pathological and prognostic study sbowes cardiac tuinors are quite different from the tumors in other sites, i.e., cven benign ones could cause fatal hemodynamic disturbance. Hence early diagnosis and early operation are necessary and if in such instance, the Prognosis of inost of the benign oncs would be good. But the prognosis of the malignant tumors is worst. The myxomas are different from the organized thrombi in heart cavity. And also the criteria of diagnosis and differential diagnosis are discussed.

Mediastinal Tuberculoma Mimicking Malignant Cardiac Tumor:A Case Report

Background:The clinical manifestations of cardiac masses are diverse and lack specifi city.Here we report a cardiac mass detected by transthoracic echocardiography.Multimodality imaging and pathological fi ndings after the operation confi rmed the mass as mediastinal tuberculoma.Case presentation:A 45-year-old male patient was admitted to our hospital reporting chest tightness,weight loss,and dyspnea for 3 months after exercise.Transthoracic echocardiography showed that there were a large number of pericardial effusions and a soft tissue mass measuring 7.7 cm×4.5 cm in the upper mediastinum,which oppressed the right pulmonary artery and accelerated the blood fl ow of the left pulmonary artery.Contrast-enhanced ultrasonography showed degenerative inhomogeneous high enhancement of and an unclear boundary in the mass.Contrast-enhanced chest CT revealed punctate and patchy calcifi cation in and uneven enhancement of the mass and the lymph nodes around the aortic arch.The mass was diagnosed as a malignant mediastinal tumor.Pathological analysis of the mass revealed chronic granulomatous tuberculosis.The symptoms abated signifi cantly after antituberculosis treatment.The patient remained asymptomatic during follow-up.Conclusion:This report presents a rare case of mediastinal tuberculoma mimicking a malignant cardiac tumor.Multimodality imaging should be incorporated for differentiation of cardiac masses.

A Rare Case of a Primary Cardiac Tumor Presenting as Fatal Ventricular Tachycardia

Primary cardiac tumors are extremely uncommon.Here,we report the case of a patient with a primary left ventricular interstitial tumor presenting with hemodynamically unstable ventricular tachycardia.In response to hemodynamically unstable ventricular tachycardia,an implantable cardioverter-defibrillator was inserted.One month after defibrillator implantation,the patient developed episodes of high ventricular tachycardia that could not be effectively terminated by catheter radiofrequency ablation,thus further confirming that the ventricular tachycardia was induced by the left ventricular interstitial tumor.The patient is doing well on medical therapy to date.

Theatment strategies for pediatric patients with primary cardiac tumors

Objective To analyze the experience of treatment strategies for pediatric patients with primary cardiac tumors. Methods The clinical data of 27 patients with primary cardiac tumors which detected by echocardiography from May 1999 to May 2009 was analyzed retrospectively. There were 20 male and 7 female patients,aged from 24 d to 12. 6 years. There were 59. 2% less than 1 year old at the time of diagnosis. A single tumor were present in 22 cases and multiple in 5 cases. Surgery was performed on 22 patients due to the varied

Conduction disorder and primary cardiac tumor: a fatal case of multiple lipomas of the right atrium

Cardiac primary tumors are uncommon with an estimated prevalence between 0.17%and 0.19%.[1,2]Cardiac lipoma are extremely rare representing only 10%?19%of primary cardiac tumors and only few are symptomatic,depending on their location within the heart.[3,4]They originate from the subendocardium(50%),subepicardium(25%)or myocardium(25%)and with different sizes and locations.[5]Few cases of sudden death due to primary cardiac tumors are reported in literature(0.0025%);in these cases,conductive and haemodinamic abnormalities have been indicated as the cause of death.

Cardiac and pericardial tumors:A potential application of positron emission tomography-magnetic resonance imaging

Cardiac and pericardial masses may be neoplastic, benign and malignant, non-neoplastic such as thrombus or simple pericardial cysts, or normal variants cardiac structure can also be a diagnostic challenge. Currently, there are several imaging modalities for diagnosis of cardiac masses; each technique has its inherent advantages and disadvantages. Echocardiography, is typically the initial test utilizes in such cases, Echocardiography is considered the test of choice for evaluation and detection of cardiac mass, it is widely available, portable, with no ionizing radiation and provides comprehensive evaluation of cardiac function and valves, however, echocardiography is not very helpful in many cases such as evaluation of extracardiac extension of mass, poor tissue characterization, and it is non diagnostic in some cases. Cross sectional imaging with cardiac computed tomography provides a three dimensional data set with excellent spatial resolution but utilizes ionizing radiation, intravenous iodinated contrast and relatively limited functional evaluation of the heart. Cardiac magnetic resonance imaging(CMR) has excellent contrast resolution that allows superior soft tissue characterization. CMR offers comprehensive evaluation of morphology, function, tissue characterization. The great benefits of CMR make CMR a highly useful tool in the assessment of cardiac masses.(Fluorine 18) fluorodeoxygluocse(FDG) positron emission tomography(PET) has become a corner stone in several oncological application such as tumor staging, restaging, treatment efficiency, FDG is a very useful imaging modality in evaluation of cardiac masses. A recent advance in the imaging technology has been the development of integrated PET-MRI system that utilizes the advantages of PET and MRI in a single examination. FDG PET-MRI provides complementary information on evaluation of cardiac masses. The purpose of this review is to provide several clinical scenarios on the incremental value of PET and MRI in the evaluation of cardiac masses.

Xuebijing alters tumor necrosis factor-alpha, interleukin-1beta and p38 mitogen activated protein kinase content in a rat model of cardiac arrest following cardiopulmonary resuscitation

We established a rat model of cardiac arrest by clamping the endotracheal tube of adult rats at expiration. Twenty-four hours after cardiopulmonary resuscitation, nerve cell injury and expression of tumor necrosis factor-α, interleukin-1β, and p38 mitogen activated protein kinase content were increased. Rats injected with Xuebijing, a Chinese herb compound preparation, exhibited normal cellular structure and morphology, dense neuronal cytoplasm, and decreased tumor necrosis factor-α, interleukin-1β, and p38 mitogen activated protein kinase expression at 24 hours following cardiopulmonary resuscitation. These data suggest that Xuebijing can attenuate neuronal injury induced by hypoxia and reperfusion during cardiopulmonary resuscitation.

EFFECT OF PEROXISOME PROLIFERATOR-ACTIVATED RECEPTOR ACTIVATORS ON TUMOR NECROSIS FACTOR-αEXPRESSION IN NEONATAL RAT CARDIAC MYOCYTES

Objective To investigate the effect of peroxisome proliferator-activated receptor-α(PPARα) and PPARγactivators on tumor necrosis factor-α(TNFα) expression in neonatal rat cardiac myocytes. Methods Primary cultures of cardiac myocytes from 1- to 3-day-old Wistar rats were prepared, and myocytes were ex-posed to lipopolysaccharide (LPS) and varying concentrations of PPARαor PPARγactivator (fenofibrate or pioglitazone).RT-PCR and ELISA were used to measure TNFα, PPARα, and PPARγexpression in cultured cardiac myocytes. Transient tr-ansfection of TNFαpromoter with or without nuclear factor-kappaB (NF-κB) binding site to cardiac myocytes was performed. Results Pretreatment of cardiac myocytes with fenofibrate or pioglitazone inhibited LPS-induced TNFαmRNA and protein expression in a dose-dependent manner. However, no significant changes were observed on PPARαor PPARγmRNA expression when cardiac myocytes were pretreated with fenofibrate or pioglitazone. Proportional suppression of TNFαpromoter activity was observed when myocytes was transiently transfected with whole length of TNFαpromoter (-721/+17) after being stimulated with LPS and fenofibrate or pioglitazone, whereas no change of promoter activity was observed with transfection of TNFαreporter construct in deletion of NF-κB binding site (-182/+17). Conclusions PPARαand PPARγactivators may inhibit cardiac TNFαexpression but not accompanied by change of PPARαor PPARγmRNA expression. Therefore PPARαand PPARγactivators appear to play a role in anti-inflammation. The mechanism may partly be involved in suppression of the NF-κB pathway.

Tumors of the cardiac conduction system:are they an explanation for otherwise unexplained sudden cardiac death?

Cardiac tumors are well described in the literature. The first reports of cardiac tumors date back hundreds of years.The prevalence of primary cardiac tumors at autopsy ranges from 0.001% to 0.3% with secondary tumors more common than in primary tumors. ……

Neuronal injury and tumor necrosis factor-alpha immunoreactivity in the rat hippocampus in the early period of asphyxia-induced cardiac arrest under normothermia

Low survival rate occurs in patients who initially experience a spontaneous return of circulation after cardiac arrest（CA）. In this study, we induced asphyxial CA in adult male Sprague-Daley rats, maintained their body temperature at 37 ± 0.5°C, and then observed the survival rate during the post-resuscitation phase. We examined neuronal damage in the hippocampus using cresyl violet（CV） and Fluore-Jade B（F-J B） staining, and pro-inflammatory response using ionized calcium-binding adapter molecule 1（Iba-1）, glial fibrillary acidic protein（GFAP）, and tumor necrosis factor-alpha（TNF-α） immunohistochemistry in the hippocampus after asphyxial CA in rats under normothermia. Our results show that the survival rate decreased gradually post-CA（about 63% at 6 hours, 37% at 1 day, and 8% at 2 days post-CA）. Rats were sacrificed at these points in time post-CA, and no neuronal damage was found in the hippocampus until 1 day post-CA. However, some neurons in the stratum pyramidale of the CA region in the hippocampus were dead 2 days post-CA. Iba-1 immunoreactive microglia in the CA1 region did not change until 1 day postCA, and they were activated（enlarged cell bodies with short and thicken processes） in all layers 2 days postCA. Meanwhile, GFAP-immunoreactive astrocytes did not change significantly until 2 days post-CA. TNF-α immunoreactivity decreased significantly in neurons of the stratum pyramidale in the CA1 region 6 hours post-CA, decreased gradually until 1 day post-CA, and increased significantly again 2 days post-CA. These findings suggest that low survival rate of normothermic rats in the early period of asphyxia-induced CA is related to increased TNF-α immunoreactivity, but not to neuronal damage in the hippocampal CA1 region.

免疫检查点抑制剂相关心肌炎的诊断与治疗研究进展

随着肿瘤学及免疫学在临床上的广泛发展,将其应用于恶性肿瘤患者的治疗现已成为抗肿瘤治疗领域的最为先进的治疗方式。作为新型抗肿瘤药物,免疫检查点抑制剂(ICIs)是肿瘤患者实施免疫治疗的重要方法,现已被广泛应用于恶性肿瘤患者的治疗。ICIs的使用对改善晚期恶性肿瘤患者的预后尤为重要,为恶性肿瘤患者的治疗带来突破性进展,可在极大程度上延长患者生存时间、提升患者的生活质量。但ICIs在治疗的同时,不可避免地带来免疫相关的不良反应,其中以ICIs相关的心肌炎发生风险较高,目前临床上对于ICIs相关心肌炎的发病机制及病因暂无明确定义,可能与T细胞激活、免疫检查、自身抗体的产生等因素存在密切联系,在此过程中若患者不及时诊断及治疗,可对其生命安全造成严重威胁。本文分别从ICIs相关心肌炎定义及发病机制分析、ICIs相关心肌炎的临床诊断、ICIs相关心肌炎的临床治疗等方面展开综述,以为临床治疗ICIs相关心肌炎提供有效的参考依据。

6例心内血性囊肿临床及病理特征分析

目的:分析心内血性囊肿的临床与病理特征,以提高对罕见心脏肿瘤的认识。方法:收集首都医科大学附属北京安贞医院2015年3月至2023年5月,诊断的6例心内血性囊肿病例,进行临床资料分析与病理形态学特征观察。结果:女性2例,男性4例;年龄25~59岁,中位年龄52.5岁。血性囊肿位于二尖瓣3例、主动脉瓣1例、三尖瓣1例、右心房1例。组织病理学表现为囊壁由纤维结缔组织构成,衬覆血管内皮细胞,腔内可见出血及血栓形成。免疫组织化学染色示CD31(+)、CD34(+)、D2-40(-)、Calretinin(-)。所有病例均完整切除,术后随访6例,均健在、无复发。结论:心内血性囊肿是极其少见的心脏良性肿瘤,术前通过超声心动图检查可高度提示此肿物可能,确诊需组织病理学检查。本病手术完整切除后通常预后良好。

国内外心脏肿瘤相关研究的CiteSpace和VOSviewer可视化分析

目的:应用CiteSpace和VOSviewer软件对国内外近20年心脏肿瘤相关研究进行可视化分析,探究领域内研究热点和发展趋势。方法:以中国知网和Web of Science为数据来源对获得的文献进行发表年份、作者、期刊、机构、关键词可视化分析。结果:共纳入中文文献1767篇、英文文献16330篇。国内外作者以许建屏、王红月、Reardon Michael J、Maleszewslci Joseph J等为代表,均已形成了各自的合作团队。发文期刊主要涉及影像学和心血管外科领域。研究机构以各大学附属医院的影像科及心血管外科为主。关键词图谱提示心脏肿瘤的诊断分型以及相关影像学技术是研究重点。结论:非手术疗法的有效性和副作用有待进一步实验验证,应用分子病理机制来开发和应用靶向治疗药物是未来的发展趋势和研究热点。

基于心电心音图—血液指标的列线图对化疗后心脏不良事件风险的预测研究

目的探讨心电心音图联合血液指标预测恶性肿瘤患者化疗后发生心脏不良事件的风险。方法前瞻性收集171例恶性肿瘤患者。根据患者化疗结束后是否出现心脏不良事件分为心脏不良事件组和无心脏不良事件组,分析两组患者一般资料、化疗前血液指标与化疗早期(1~3周期)心电心音图相关指标,将可能影响因素进行二元Logistic回归分析确定独立预测因素并绘制列线图,利用受试者操作特征(ROC)曲线评估列线图预测能力。结果171例患者化疗结束后有44例发生心脏不良事件,发生率25.73%。二元logistic回归结果表示年龄、化疗前红细胞分布宽度(RDW)、活化部分凝血酶原时间(APTT)和化疗早期心脏电−机械激动时间(EMAT)是化疗患者发生心脏不良事件的独立预测因子,基于此绘制列线图,ROC曲线评估AUC为0.768(95%CI:0.693~0.843,P<0.001)。结论基于年龄、化疗前RDW、APTT和化疗早期EMAT绘制的列线图有助于早期评估化疗患者发生心脏不良事件的风险。

Primary Cardiac Lymphoma: Three Case Reports and a Review of the Literature

Primary cardiac lymphoma (PCL) is a rare entity that comprises only 1% - 2% of all cardiac tumors. Due to their scarcity and variable clinical presentation, early diagnosis is challenging. In this series, three cases of PCL from a single institution are described, which highlight the spectrum of presenting features and emphasize common principles. In the first case, a 73-year-old male who presented with dyspnea was found to have a 12.1 cm mass in the right ventricle. Biopsy via cardiac catheterization revealed diffuse large B cell lymphoma (DLBCL). He was treated with chemoimmunotherapy and survived for two months. The second case describes a 55-year-old female who presented with chest pain. Imaging revealed a 3.1 cm right atrial mass and bilateral pleural effusions, with cytology from the latter demonstrating DLBCL. She was lost to follow up after three cycles of chemoimmunotherapy. In the last case, an 80-year-old female presented with weakness. A 4.0 cm mass was discovered in the right atrium and the patient expired shortly after admission. Autopsy confirmed the diagnosis of DLBCL. These case summaries are followed by a review of the clinical presentation, diagnostic approach, and treatment outcomes of PCL.

宫颈鳞癌三尖瓣转移合并先心病1例报告及文献复习

宫颈癌主要转移途径包括:局部侵犯,淋巴结转移,血行转移。晚期常转移至肺、肝、骨、脑及远处淋巴结[1-2],罕见转移至心脏,根据尸检结果,宫颈癌心脏转移的发生率为0.3%~8.0%,死亡前诊断率仅4.0%[3-4]。转移部位多位于心外膜或心肌,极其罕见于心脏瓣膜[5]。宫颈癌心脏转移后的平均生存期仅6个月[6],大部分患者在1年内死亡[5],系统性治疗为转移以后的主要治疗手段,局部治疗有助于改善症状。

风湿性心脏病合并二尖瓣乳头状弹力纤维瘤1例

目的探究发生于心脏瓣膜的乳头状弹力纤维瘤的临床及病理特征,为临床治疗提供参考。方法对1例风湿性心脏病合并二尖瓣腱索乳头状弹力纤维瘤病人,进行手术治疗,对二尖瓣肿物的标本行病理检查进行形态学研究,并复习文献。结果心脏乳头状弹力纤维瘤病人多无特殊症状。心脏超声表现为二尖瓣腱索见一条索状稍强回声。组织学表现为:肿瘤呈乳头状突起,表面被覆单层立方上皮细胞,中心为无血管的轴心区,主要部分是特征性的淡红色的弹力纤维组织。结论风湿性心脏病是一种常见的心脏疾病,而乳头状弹力纤维瘤是一种少见且发病隐匿的心脏肿瘤,病人常无明显症状,可引起栓塞风险。该例肿瘤位于二尖瓣乳头肌腱索处很罕见。术前行超声心动图及手术完整切除肿瘤是提高心脏乳头状弹力纤维瘤病人诊断率及治疗的关键。

Six Years Clinical Experience and Surgical Considerations in Management of Cardiac Myxoma in Iraqi Center for Heart Disease—Single Center Experience

Background: Cardiac myxomas are the most frequently encountered benign cardiac tumors that if left untreated are inexorably progressive and potentially fatal. Surgery is the only way of treatment, and if not treated with the right surgical technique recurrence occurs. Objectives: In this single center study we documented the patterns of presentation, localization, surgical approaches and outcome of cardiac myxomas. Methods: This is a retrospective study of 20 patients who underwent surgical removal of atrial myxoma from January 2010 to December 2015. All patients underwent general investigations, and echocardiography was performed on all patients and surgery was done using extracorporeal circulation and mild hypothermia. Results: The ages of the patients ranged from 14 years to 71 years, with a mean of 51.45 years. Most myxomas (75%) originated from left atrium, 20% from right atrium and biatrial in 5% of cases. The male-to-female ratio was 1:2.3 (14 females and 6 males). Myxomas were more common in blood group A+ and B+. Chief complaints were dyspnea (70%) and palpitation (50%). The majority of masses were attached to the interatrial septum (65%) and four of cases (20%) arose from the lateral wall. Right atrial trans-septal incision was used in 55% of cases. No recurrence was recorded in our study. Six patients had postoperative complications, mainly in the form of arrhythmia (3 cases), bleeding (0ne case) and renal failure (one case) which resulted in the death of the patient. Conclusions: Cardiac myxoma excision account for a very small percentage of cardiac procedures. Immediate surgical treatment is indicated because of high risk of embolization and sudden death. Cardiac myxomas can be excised with a low rate of mortality and morbidity. Follow-up examination, including echocardiography, should be performed regularly.

沙库巴曲缬沙坦防治肿瘤治疗相关心功能不全的效果分析

目的:探讨沙库巴曲缬沙坦治疗肿瘤治疗相关心功能不全(cancer therapy-related cardiac dysfunction,CTRCD)的疗效。方法:汇总分析自建库至2023年3月发表于Pubmed、Web of Science、Cochrane Library、Medline、Embase五大数据库的沙库巴曲缬沙坦治疗CTRCD的所有文献,归纳总结用药时机、剂量、药物疗效等;梳理总结其预防CTRCD的临床研究。结果:使用沙库巴曲缬沙坦治疗CTRCD 3~12个月后,肿瘤患者NYHA心功能从Ⅱ~Ⅳ级改善为Ⅰ~Ⅱ级,LVEF上升幅度为3.0%~37.0%,NTproBNP下降幅度为280.0~65498.0 pg/mL。结论:沙库巴曲缬沙坦治疗CTRCD有效,在改善患者LVEF、GLS等指标方面具有较好的临床应用价值,使肿瘤患者抗肿瘤治疗得以继续、生存期得以延长。