Primary cardiac tumors are classified into benign or malignant. Benign tumors are more common than malignant. In our experience 96% of tumors were benign, myxomas were the more common (69%) followed by papillary fibroelastomas (24.2%). Nevertheless cardiac tumors may be considered benign www.selleckchem.com/products/MDV3100.html histologically but surely not clinically. Indeed in our experience 33 patients (36.3%) had serious embolic events, 24% in the myxoma group and 82% in the fibroelastoma group. We found that in case of myxoma the patients who suffered from an embolic events, the histological evaluation showed in the 89.6% of the cases a weight major than 25g with multiple area of hemorrhagic necrosis inside the mass.

We think that during growth of the myxomas is achieved a critical dimension beyond which the tumor becomes necrotic because of the discrepancy between mass and nutrients, increasing the risk of fragmentation and embolism. Severe congestive heart failure due to obstruction of mitral or tricuspid inflow may be the presentation of atrial myxomas as happens in 7 of our cases. The mean mass of obstructive tumors were major than 47g with a mean dimension of 4.5��4��3.8cm. In six patients the papillary fibroelastoma of aortic valve has been responsible of an acute myocardial infarction due to coronary embolism documented during selective angiography. Eight patients suffered from an embolic stroke. Malignant ventricular arrhythmia was the clinical presentation of two fibroelastomas of right ventricle. In our patients the clinical presentation of fibroelastomas has emerged more malignant with a higher incidence of severe embolic events or malignant arrhythmia than myxomas.

Therefore in our opinion any of these tumors should be removed by urgent indication supported by low surgical mortality (6,9,10). Moreover it has been demonstrated that less invasive approaches could be used safety (11). An interesting issue is the risk of recurrence in particular in case of myxomas. Some authors recommend a wide excision with patch repair (10,11). In our series of myxomas, the patch repair was used in 43 patients (68.3%). During the follow-up period we had three recurrence of myxoma in patients that underwent first resection without patch repair (16.7% 3/18patients without patch repair) after 29 and 46 months respectively. The familial histories of these patients were negative for cardiac myxomas and Carney syndrome (12).

Recurrence can be due to inadequate resection, intraoperative implantation, embolization or multicentric growth (13). Then the GSK-3 cause of relapse, in our patients, is probably an incomplete removal of the tumor at the level of the base of implantation. Indeed the tumors were located very closely with the previous incision. Therefore in the last ten years we use systematically the patch repair and we have not seen further recurrence.