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MID-ESOPHAGEAL 4 CHAMBER

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Chamber size Ventricular function Mitral Valve disease Tricuspid Valve disease Atrial Septal Defect Pericardial Effusion

Mouzarou Angeliki MD

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Mouzarou Angeliki MD

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MID ESOPHAGEAL AORTIC VALVE SAX

Use this view to Diagnose

Aortic Valve disease Atrial septal defect (ASD) (secundum) LA size Coronary artery pathology 28.05.2011

Mouzarou Angeliki MD

Mouzarou Angeliki MD

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MID ESOPHAGEAL AORTIC VALVE LAX

Use this View to Diagnose

Mitral Valve disease Aortic Valve disease Aortic Root dimensions and pathology LVOT pathology Ventricular Septal Defect (VSD)
Mouzarou Angeliki MD 28.05.2011

MID ESOPH. AORTIC VALVE LAX

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Mouzarou Angeliki MD

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CARDIAC TUMOR
Definition Cardiac tumors include benign and malignant neoplasms arising within the cardiac chambers or in the myocardium. History Columbus : 1st recognition in 1559 followed by Malpighi in 1666, Morgagni in 1762 Yater : Dissertation & tabulation of primary cardiac tumor in 1931, 1st clinical diagnosis recorded in 1934 Bahnson & Newman : Removal of RA myxoma without CPB in 1952 Crafoord : Excision of myxoma from left atrium with CPB

Mouzarou Angeliki MD

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PRIMARY CARDIAC TUMORS

 Introduction Primary cardiac tumors are uncommon clinical entities with an incidence of 0.0017% to 0.03% The majority of these tumors are benign atrial myxomas, successfully managed by surgical excision Malignant cardiac tumors continue to present a difficult therapeutic challenge, and surgical resection is often necessary to alleviate the severe symptoms associated with these tumors, but is, nevertheless, associated with poor long-term prognosis Because of the rarity of primary cardiac malignancies, therapeutic concepts and methods of surgical resection have not been standardized.

Mouzarou Angeliki MD

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PRIMARY CARDIAC TUMORS

 Types Benign ; approximately 70% Myxoma 29.3%, Lipoma 10.1%,Primary fibroelastoma 9.5%, Rhabdomyoma 8.1%, Fibroma 3.8%, Hemangioma 3.4%, Teratoma 3.2%, Mesothelioma of AV node 2.7%, Granular cell tumor, Neurofibroma, Lymphangioma Malignant ; approximately 30% Angiosarcoma 8.8%, Rhabdomyosarcoma 5.8%, Mesothelioma 4.2%, Fibrosarcoma 3.2%, lymphoma 1.6%, Extraskeletal osteosarcoma 1.1%, Neurogenic sarcoma, Malignant teratoma, Leiomyosarcoma, Liposarcoma, Synovial sarcoma

Mouzarou Angeliki MD

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PRIMARY CARDIAC NEOPLASMS

 Clinical features 1. Incidence 0.001~0.03% with an autopsy 2. Nature Benign ; 70 75% myxoma (1/2), lipoma , papillary fibroelastoma, rhabdomyoma, etc Malignant ; 25 - 30% sarcomas (3/4), mesothelioma, lymphoma 3. Symptoms Embolism, intracardiac obstruction, infiltration constitutional symptoms (CHF, palpitation)

Mouzarou Angeliki MD

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CARDIAC MYXOMA
Definition Primary cardiac tumors that are generally pedunculated, polypoid but may have a broad base. The cells are uniform, small, and polygonal, with round or oval nuclei and a moderate amount of cytoplasm of myxoid matrix of acid mucopolysaccharide. They lie in a myxomatous stroma in which elements are seen and covered by endothelium and endothelium-lined crevices and clefts. Morphology Myxomas are intracavitary tumors occurring within any of the cardiac chamber, but they have a predilection for the atria and particularly the left atrium, usually 5 to 6 cm in diameter

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CARDIAC MYXOMA
 Nature Increasing numbers of reports indicate the malignant potential. Extensive local invasion has been noted. Nearly all solitary myxoma have a normal DNA ploidy (chromosomal pattern), and nearly all nonfamilial. Multiple myxomas usually have an abnormal DNA ploidy pattern, are usually familial in their occurrence, and tend to recur. In rare circumstances, atrial myxomas may become infected.

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CARDIAC MYXOMA
Location Atrial myxoma
Majority of atrial myxoma, whether left or right, arise from the atrial septum (90%), usually from limbus of fossa ovalis. 80 90% of myxomas are in the left atrium.

Ventricular myxoma
Found mainly on the right ventricular free wall or ventricular septum, sometimes described as infiltrating

Valvar myoxoma
Rare reports arising from tricuspid, mitral, and pulmonary valve

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CARDIAC MYXOMA
 Pathophysiology Hemodynamic derangement Obstruct pulmonary or systemic venous drainage or impair flow across AV valve progressively. When such obstruction is intermittent, syncope, often related postural change, or sudden death. Embolism Systemic emboli occur in 30 to 45% with left atrial myxoma. Embolism from right-sided tumor occurs in 10%, may cause fatal pulmonary obstruction, or pulmonary hypertension. Constitutional manifestations A plethora of constitutional symptoms and laboratory findings may be only the manifestations and these occur in 30%. Fever, weight loss, clubbing, Raynauds phenomenon, myalgia, arthralgia, unusually polycythemia, hemolytic anemia, thrombocytopenia. Immune reaction to neoplasm(elevated globulin) result in constitutional symptoms and elevated ESR & C-reactive protein.

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CARDIAC MYXOMA
 Patterns Familial 1. 5% of patients, Mandelian dominant inheritance 2. Primarily young men, less commonly (62%) in left atrium, more often multiple(33%), 20 % of patients associated with other unusual conditions (Cushing, pituitary tumor, Sertoli cell tumor of testis, centrofacial and labial lentigenosis, cutaneous myxoma, multiple mammary fibroadenoma ) 3. Strong tendency to recurrence 4. Abnormal DNA ploidy pattern Nonfamilial (sporadic) 1. Primarily of middle aged women 2. Usually single (94%), in left atrium (75%), uncommonly associated conditions and uncommonly recur. 3. Only about 20% have abnormal DNA ploidy pattern

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CARDIAC MYXOMA
Natural history Incidence Prevalent in older adult, 2-3 times more common in female, rare in child Natural course * Highly variable * Once symptoms of dyspnea and hemoptysis develop in left atrial myxoma, or symptoms of abdominal protuberance from ascites or hepatomegaly in right atrial myxoma, rapidly progress to death within 1 2 years onset.

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CARDIAC MYXOMA
Surgical treatment Indication Indicated whenever a diagnosis of cardiac myxoma is made on urgent basis Technique Atrial myxoma ; sufficient excision of atrial septum if possible, uninvolved tissue 5 mm beyond Other myxoma ; ventricular myxoma does not require excision of fullthickness ventricular wall

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CARDIAC MYXOMA
Surgical results Survival Early death ; uncommon Time-related survival ; uncommon except recurrence Recurrence Sporadic ; unusual, only 1-3% Familial ; 30-70% recurrence, probably related, 40% of patients with abnormal DNA ploidy pattern Postoperative arrhythmias Atrial arrhythmias are common Functional status ; generally good

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28.05.2011 Heart and Soul Nebula

MID-ESOPHAGEAL RIGHT VENTRICLE

Use this view to Diagnose

Mouzarou Angeliki MD

Pulmonic Valve disease Pulmonary Artery pathology RVOT pathology Tricuspid Valve disease Ventricular Septal Defect
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Mouzarou Angeliki MD

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