Benign Cardiac Tumors Treatment & Management

Updated: Aug 05, 2016
  • Author: Dale K Mueller, MD; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Treatment

Medical Care

Medical management is not indicated unless symptoms are minimal, operative risks are prohibitive, or tumor size limits adequate resection. Thus, medications are not indicated for primary treatment.

Rhabdomyomas have a high tendency to regress, therefore close follow-up with a pediatric cardiologist is needed. Indications for resection are usually for severe intracavitary obstruction.

Consult with the following specialists:

  • Cardiologist
  • Cardiothoracic surgeon
  • Oncologist if malignant disease is suspected
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Surgical Care

Complete surgical resection of benign masses typically is curative. [2, 10]  Note the following:

  • Expediated treatment is recommended because the risk for embolization is high in myxoma. [11] The risk for lethal arrhythmias does not drive this decision.
  • Resection typically involves cardiopulmonary bypass with cardiac arrest.
  • Cardiac autotransplantation is also a feasible technique for resection of complex left-sided cardiac tumors. [12]
  • Cardiac transplantation has been reported in persons with large, unresectable tumors. [13, 14]

Fibromas should be resected, if possible, due to impedance of cardiac flow, ventricular contraction abnormalities, and conduction abnormalities. Also lethal arrhythmias are a risk in cardiac fibroma; based on this, excision should be considered, even in asymptomatic patients.

Ventricular tumors should be resected to preserve ventricular function, maintain valve function, and preserve as much of the conduction system as possible.

No restrictions on activity are necessary following elective resection (other than usual postoperative restrictures during the recovery phase).

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Long-Term Monitoring

Routine transthoracic echocardiographic evaluation is recommended every 2-5 years to evaluate for recurrence.According to American Heart Association guidelines, to minimize the risk of endocarditis, instruct the following patients to take prophylactic antibiotics:

  • Patients with residual postoperative valvular dysfunction
  • Patients with implanted prosthetic valves or artificial materials (used to repair postresection myocardial defects)
  • Patients with outflow tract obstruction
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