Cardiac tumours are rare and most are benign. Myxomas, 90% of which occur in the left atrium, are the commonest of the benign tumours though lipoma, fibroma, rhabdomyoma, haemangioma and fibroelastoma also occur. The malignant tumours include the sarcomatous tumours corresponding to the above benign tumours.

Presentation

Cardiac tumours present with syncopal attacks due to obstruction of flow within cardiac chambers, valve incompetence due to impairment of valve closure, symptoms of embolisation, rarely arrythmia or constitutional symptoms such as fever, weight loss, finger clubbing, Raynaud’s syndrome or myalgia.

Investigation

Echocardiography outilines the intracardiac disease and allows planning of surgical resection. Cardiac catheterisation is usually contraindicated because of the risk of inducing embolisation, unless other cardiac or coronary surgery is anticipated. CT scan will outline the extent of extracardiac disease.

There is no non-invasive method of distinguishing between a benign or a malignant cardiac lesion. Therefore surgical exploration is required for any symptomatic or clinically suspicious intra-cardiac mass. Even histologically benign lesions can prove fatal by virtue of their location or propensity for embolisation.

Treatment and prognosis

1. •Surgical resection by open heart surgery under cardio-pulmonary bypass is curative for the majority of atrial myxomas and other benign tumours. Malignant neoplasms are rarely cured with surgery alone though patients whose tumours have been resected have a median survival of twenty-four months compared to eleven months for patients with unresectable tumours.
   

2. •Multimodality therapy has rarely been shown to change the prognosis.
   

3. •Orthotopic cardiac transplantation is an alternative treatment for patients without metastatic spread but in whom complete tumour excision is not possible by standard techniques. This approach, unique in cancer surgery, has shown promising results in a number of small series, despite concerns about the immunosuppressive effects of cardiopulmonary bypass and anti-rejection medication.