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Therapy Insight: malignant primary cardiac tumors

Nature Clinical Practice Cardiovascular Medicine volume 3, pages 548–553 (2006)Cite this article

Abstract

Benign cardiac tumors are resected with a high degree of success with modern cardiac surgical techniques. Malignant cardiac tumors, however, continue to pose a therapeutic challenge to cardiac surgeons and oncologists because of the technical difficulty involved in extensive cardiac resections and the aggressive biological nature of the tumors. The majority of malignant cardiac tumors are sarcomas and can be categorized as right heart sarcoma, left heart sarcoma or pulmonary artery sarcoma. Right heart sarcomas are generally angiosarcomas, which infiltrate widely and metastasize early. A combination of chemotherapy and surgical resection is the preferred therapy. Left heart sarcomas, although large, are often less infiltrative and metastasize later than right heart sarcomas, but a similar approach to treatment is usually employed. Surgical resection is more-frequently necessary for left heart sarcomas because of intracardiac blood flow obstruction and congestive heart failure, although the anatomic position and relation of these tumors to cardiac structures can complicate surgery. We have developed and employed the technique of cardiac autotransplantation, which involves cardiac excision, ex vivo tumor resection with cardiac reconstruction, and cardiac reimplantation, to lessen these technical difficulties. Pulmonary artery sarcomas can be treated by radiotherapy, as well as by the other therapies, because the myocardium can be avoided by the radiation fields. Surgical resection of this sarcoma type often requires pneumonectomy and can require pulmonary root replacement.

Key Points

  • Primary cardiac malignant tumors are rare and are generally sarcomas

  • Primary cardiac malignant tumors usually require a multimodality approach, and sometimes complex surgical resections

  • In our center, we classify cardiac sarcomas into right heart sarcomas, left heart sarcomas and pulmonary artery sarcomas because of the differences in surgical approaches for each type

  • Use of aggressive forms of surgical resection and multimodality therapy can improve survival in some patients

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Figure 1: An extensive right atrial sarcoma.
Figure 2: Artist's depiction of a right atrial sarcoma and the stages of resection and reconstruction.
Figure 3: Echocardiograms of left atrial tumors.
Figure 4: Artist's representation of cardiac explantation, resection, reconstruction and reimplantation to treat a left atrial sarcoma.
Figure 5: CT scan of pulmonary artery sarcoma showing almost complete obstruction of the main pulmonary arteries by an angiosarcoma.

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Authors and Affiliations

  1. MD Anderson Cancer Center,

    Michael J Reardon, Jon-Cecil Walkes & Robert Benjamin

  2. Methodist DeBakey Heart Center,

    Michael J Reardon, Jon-Cecil Walkes & Robert Benjamin

  3. MD Anderson Cancer Center, Houston, TX, USA

    Michael J Reardon, Jon-Cecil Walkes & Robert Benjamin

Authors
  1. Michael J Reardon
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  2. Jon-Cecil Walkes
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  3. Robert Benjamin
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Correspondence to Michael J Reardon.

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The authors declare no competing financial interests.

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Reardon, M., Walkes, JC. & Benjamin, R. Therapy Insight: malignant primary cardiac tumors. Nat Rev Cardiol 3, 548–553 (2006). https://doi.org/10.1038/ncpcardio0653

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