Pediatric Cardiac Tumors Treatment & Management

  • Author: Edwin Rodriguez-Cruz, MD; Chief Editor: Steven R Neish, MD, SM   more...
 
Updated: Dec 1, 2011
 

Medical Care

Most childhood cardiac tumors are benign, with no treatment necessary unless the tumor severely obstructs blood flow or causes intractable arrhythmias. Most only require close follow-up care.

New data have addressed the use of serum creatine kinase-myocardial band (CK-MB) fraction levels in evaluating ventricular function. Greater ventricular dysfunction correlated with higher CK-MB levels.

Nonetheless, examine the patient extensively and expeditiously because finding a tumor is a stressful situation for both patient and family. By reaching a prompt and precise diagnosis, the physician can proceed with the best treatment approach.

The mode of treatment varies and cannot be easily simplified because the kind of tumor (benign vs malignant, infiltrative vs localized) dictates therapy. Location and extent of the tumor, as well as symptoms, are clinical variables that direct treatment. Observation is sufficient when the mass is small and does not interfere with vascular hemodynamics. However, the clinician must be aggressive when the tumor is causing hemodynamic problems. In occasions, electrical problems may also arise due to the location requiring resection and/or implantation of a pacemaker if atrioventricular block occurs.

Next

Surgical Care

Many advocate excision of the mass as soon as it is found; however, most childhood tumors are benign and do not require resection. Nevertheless, if a tumor is causing severe obstruction or intractable arrhythmias and has been rendered resectable, perform surgery as soon as possible.

  • Excision and biopsy: If excision is required, perform it as extensively and completely as possible. Certain tumors recur even after complete excision. An extensive resection carries its own risks since, occasionally, removal of papillary muscles, valves, chordae tendineae, and conduction tissue are necessary.
  • Heart transplantation is an option for unresectable benign masses causing hemodynamic compromise. Transplantations have been performed with variable results for primary malignant cardiac tumors in children and adults without evidence of metastases.
Previous
Next

Consultations

Consult a cardiologist, thoracic and cardiovascular surgeon, pathologist, radiologist, and hematologist/oncologist.

Previous
Next

Diet

No dietary restrictions are needed. Occasionally, certain restrictions such as low-sodium diet for congestive heart failure (CHF) are required.

Previous
Next

Activity

Advise no restrictions unless clinical condition merits otherwise.

Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Edwin Rodriguez-Cruz, MD  Assistant Professor, Department of Pediatrics, San Juan Bautista Medical School and Medical Center; Consulting Interventional/Clinical Pediatric Cardiologist, Department of Pediatrics, Hospital El Maestro and San Juan Bautista Medical Center; Consulting Interventional/Clinical Pediatric Cardiologist, Department of Cardiology, Cardiovascular Center of Puerto Rico and the Caribbean and Veterans Affairs Hospital and Medical Center of Puerto Rico

Edwin Rodriguez-Cruz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Heart Association, American Medical Association, American Society of Echocardiography, Puerto Rico Medical Association, Society of Cardiac Angiography and Interventions, and Society of Pediatric Echocardiography

Disclosure: NOVARTIS Grant/research funds INVESTIGATOR

Coauthor(s)

Rosa M Cintrón-Maldonado, MD  Clinical Instructor of Pediatrics, Department of Pediatrics, San Juan Bautista Medical Center

Rosa M Cintrón-Maldonado, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Robert D Ross, MD  Director of Pediatric Cardiology Fellowship Program, Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Michigan; Professor of Pediatrics, Wayne State University School of Medicine

Robert D Ross, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, and Society of Pediatric Echocardiography

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey Allen Towbin, MD, MSc, FAAP, FACC, FAHA  Professor, Departments of Pediatrics (Cardiology), Cardiovascular Sciences, and Molecular and Human Genetics, Baylor College of Medicine; Chief of Pediatric Cardiology, Foundation Chair in Pediatric Cardiac Research, Texas Children's Hospital

Jeffrey Allen Towbin, MD, MSc, FAAP, FACC, FAHA is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American College of Cardiology, American College of Sports Medicine, American Heart Association, American Medical Association, American Society of Human Genetics, Cardiac Electrophysiology Society, New York Academy of Sciences, Society for Pediatric Research, Texas Medical Association, and Texas Pediatric Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Ameeta Martin, MD  Clinical Associate Professor, Department of Pediatric Cardiology, University of Nebraska College of Medicine

Ameeta Martin, MD is a member of the following medical societies: American College of Cardiology

Disclosure: Nothing to disclose.

Gilbert Z Herzberg, MD  Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center

Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Steven R Neish, MD, SM  Director of Pediatric Cardiology Fellowship Program, Associate Professor, Department of Pediatrics, Baylor College of Medicine

Steven R Neish, MD, SM is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and American Heart Association

Disclosure: Nothing to disclose.

References

  1. Lam KY, Dickens P, Chan AC. Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies. Arch Pathol Lab Med. Oct 1993;117(10):1027-31. [Medline].

  2. Miyake CY, Del Nido PJ, Alexander ME, Cecchin F, Berul CI, Triedman JK, et al. Cardiac tumors and associated arrhythmias in pediatric patients, with observations on surgical therapy for ventricular tachycardia. J Am Coll Cardiol. Oct 25 2011;58(18):1903-9. [Medline].

  3. Kono T, Koide N, Hama Y, et al. Expression of vascular endothelial growth factor and angiogenesis in cardiac myxoma: a study of fifteen patients. J Thorac Cardiovasc Surg. Jan 2000;119(1):101-7. [Medline].

  4. Beroukhim RS, Prakash A, Buechel ER, Cava JR, Dorfman AL, Festa P, et al. Characterization of cardiac tumors in children by cardiovascular magnetic resonance imaging: a multicenter experience. J Am Coll Cardiol. Aug 30 2011;58(10):1044-54. [Medline].

  5. Grant FD, Treves ST. Nuclear medicine and molecular imaging of the pediatric chest: current practical imaging assessment. Radiol Clin North Am. Sep 2011;49(5):1025-51. [Medline].

  6. Butany J, Nair V, Naseemuddin A, et al. Cardiac tumours: diagnosis and management. Lancet Oncol. Apr 2005;6(4):219-28. [Medline].

  7. Dhillon G, Rodriguez-Cruz E, Kathawala M, Alqassem N. Primary cardiac myofibroblastic sarcoma, case report and review of diagnosis and treatment of cardiac tumors. Bol Asoc Med P R. Jul-Dec 1998;90(7-12):130-3. [Medline].

  8. Farooki ZQ, Ross RD, Paridon SM, et al. Spontaneous regression of cardiac rhabdomyoma. Am J Cardiol. Apr 15 1991;67(9):897-9. [Medline].

  9. Gaumann A, Strubel G, Bode-Lesniewska B, Schmidtmann I, Kriegsmann J, Kirkpatrick CJ. The role of tumor vascularisation in benign and malignant cardiovascular neoplasms: a comparison of cardiac myxoma and sarcomas of the pulmonary artery. Oncol Rep. Aug 2008;20(2):309-18. [Medline].

  10. Le Guyader A, Laskar M. Removal of left ventricular tumors by a transaortic transvalvular approach with the help of thoracoscopic instruments. J Thorac Cardiovasc Surg. Aug 2008;136(2):537-8. [Medline].

  11. Lopez M, Pinto A, Moreno V, Diaz M, Gonzalez Baron A. Primary cardiac osteosarcoma. Clin Transl Oncol. Aug 2008;10(8):515-6. [Medline].

  12. Ludomirsky A. Cardiac tumors. In: Bricker JT, Fisher DJ, eds. The Science and Practice of Pediatric Cardiology. Vol 2. 9th ed. Williams & Wilkins; 1998:1885-93.

  13. Martinez Quesada M, Trujillo Berraquero F, Almendro Delia M, et al. [Cardiac hamartoma. Case report and literature review]. Rev Esp Cardiol. Apr 2005;58(4):450-2. [Medline].

  14. Marx GR. Cardiac Tumors. In: Emmanouilides GC, Gutgesell HP, Riemenschneider TA, Allen HD, eds. Moss and Adams Heart Disease in Infants, Children, and Adolescents: Including the Fetus and Young Adult. Vol 2. 5th ed. Baltimore, MD: Williams & Wilkins; 1995:1773-86.

  15. McAllister HA, Fenoglio JJ Jr. Tumors of the cardiovascular system: atlas of tumor pathology, second series. In: Washington, DC: Armed Forces Institute of Pathology. 1978.

  16. Padalino MA, Basso C, Milanesi O, et al. Surgically treated primary cardiac tumors in early infancy and childhood. J Thorac Cardiovasc Surg. Jun 2005;129(6):1358-63. [Medline].

  17. Piazza N, Chughtai T, Toledano K, et al. Primary cardiac tumours: eighteen years of surgical experience on 21 patients. Can J Cardiol. Dec 2004;20(14):1443-8. [Medline].

  18. Rodriguez-Cruz E, Cintron-Maldonado RM, Bercu BA. Primary cardiac osteogenic sarcoma treated with heart transplantation. Bol Asoc Med PR. 1999;91 (7-12):98-99. [Medline].

  19. Rodriguez-Cruz E, Cintron-Maldonado RM, Forbes TJ. Treatment of primary cardiac malignancies with orthotopic heart transplantation. Bol Asoc Med P R. Apr-Aug 2000;92(4-8):65-71. [Medline].

  20. Takach TJ, Reul GJ, Ott DA, Cooley DA. Primary cardiac tumors in infants and children: immediate and long-term operative results. Ann Thorac Surg. Aug 1996;62(2):559-64. [Medline].

  21. Tatli S, Lipton MJ. CT for intracardiac thrombi and tumors. Int J Cardiovasc Imaging. Feb 2005;21(1):115-31. [Medline].

  22. Tazelaar HD, Locke TJ, McGregor CG. Pathology of surgically excised primary cardiac tumors. Mayo Clin Proc. Oct 1992;67(10):957-65. [Medline].

  23. Wu XM, Hu CZ, Li N, et al. [Relationship of serum level of creatine kinase of MB type to cardiac function of patients with advanced tumors and its prognostic value]. Ai Zheng. Apr 2005;24(4):506-8.abs. [Medline].

 
Previous
Next
 
Echocardiographic parasternal long-axis view showing a large mass within the left ventricular cavity invading or connected to the anterior mitral valve leaflet. AO=Aorta, RV=Right ventricle, LA=Left atrium, Arrow=Left ventricular mass.
Echocardiographic subcostal view of a patient with a large mass within the left ventricular cavity invading or connected to the anterior mitral valve leaflet. Mass within the left ventricle fills most of the ventricular cavity. LA=Left atrium, RA=Right atrium, RV=Right ventricle, Arrow=Left ventricular mass.
Echocardiographic parasternal long-axis view demonstrating a rounded mass in the area of the right ventricular outflow tract. Mass was not causing any outflow obstruction. RV=Right ventricle, LV= Left ventricle, AO=Aorta, Arrow=Right ventricular mass.
Echocardiographic apical 5 chamber view of a 1 month old patient with several ventricular tumors filling the ventricular cavities in both sides. The patient was having seizures and diagnosed to have tuberous sclerosis. The tumor associated with this disease is rhabdomyoma (see text). RA= Right Atrium; Ao= Aorta; LA= Left Atrium; RV= Right Atrium; LV= Left Ventricle
Follow-up echocardiographic 4 chamber view from the same patient as shown in the image above. This echocardiogram was done 8 months after the previous view. Note that the tumors have changed in size and some of them have regressed totally, especially in the right ventricle. The arrows show the remaining areas of tumors seen in both ventricles.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.