Pediatrik kalp cerrahisinde nadir ameliyatlar: Çocukluk çağı kalp tümörleri

Amaç: Bu çalışmada çocukluk çağı primer kalp tümörlerinin cerrahi tedavisine ilişkin 12 yıllık deneyimimiz sunuldu. Çalışma planı: Ocak 2005 - Aralık 2017 tarihleri arasında merkezimizde primer kalp tümörü nedeni ile ameliyat edilen 13 pediatrik hasta (8 erkek, 5 kız; ort. yaş 1.3±1.9 yıl; dağılım, 3 gün-6 yıl) bu çalışmaya alındı. Veriler hastanemiz tıbbi kayıtlarından retrospektif olarak incelendi. Bulgular: Rezeke edilen kitlelerin tümü benign idi. En sık görülen tümör rabdomiyomayı takiben (n=7), fibroma (n=3), miksoma (n=2) ve perikardiyal teratoma (n=1) idi. İki hasta ameliyat sonrası erken dönemde kaybedildiği için mortalite oranı %15.4 idi. Diğer hastalarda ameliyat sonrası erken ve geç dönemde rezidüel kitle veya tümör nüksü görülmedi. Sonuç: Çocukluk çağı primer kalp tümörleri genellikle benign olmakla birlikte, tümörün yerleşimi ve büyüklüğüne bağlı olarak klinik açıdan önemli sorunlara yol açabilmektedirler. Cerrahi tümör rezeksiyonu genellikle uzun dönem iyi sonuçlar ile ilişkilidir.

Rare operations in pediatric heart surgery: Cardiac tumors in childhood

Background: In this study, we present our 12-year experience inthe surgical treatment of primary cardiac tumors in childhood.Methods: Thirteen pediatric patients (8 males, 5 females; meanage 1.3±1.9 years; range, 3 days to 6 years) who were operatedfor a primary cardiac tumor in our center between January 2005and December 2017 were included in this study. The data wereevaluated retrospectively based on our medical records.Results: All of the masses resected were benign. However, themost common tumor was rhabdomyoma (n=7), followed byfibroma (n=3), myxoma (n=2), and pericardial teratoma (n=1).The mortality rate was 15.4%, as two patients died in the earlypostoperative period. No residual mass or tumor recurrencewas observed in the early and late postoperative period in theremaining patients.Conclusion: Although primary cardiac tumors in childhoodare usually benign, they may cause clinically significantproblems depending on the localization and size of the tumor.Surgical tumor excision is often associated with good long-termoutcomes.

PDF

___

Patel J, Sheppard MN. Pathological study of primary cardiac and pericardial tumours in a specialist UK Centre: surgical and autopsy series. Cardiovasc Pathol 2010;19:343-52.
Motwani M, Kidambi A, Herzog BA, Uddin A, Greenwood JP, Plein S. MR imaging of cardiac tumors and masses: a review of methods and clinical applications. Radiology 2013;268:26-43.
Kutsal A, Koç M. Left ventricular myxoma. EJCM 2015;3:27-30.
Barreiro M, Renilla A, Jimenez JM, Martin M, Al Musa T, Garcia L, et al. Primary cardiac tumors: 32 years of experience from a Spanish tertiary surgical center. Cardiovasc Pathol. 2013;22:424-7.
Beghetti M, Gow RM, Haney I, Mawson J, Williams WG, Freedom RM. Pediatric primary benign cardiac tumors: a 15-year review. Am Heart J 1997;134:1107-14.
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 2011;58:1903-9.
Bruce CJ. Cardiac tumours: diagnosis and management. Heart 2011;97:151-60.
Kuplay H, Kurç E, Mete EM, Kuş Z, Erdoğan SB, Akansel S, et al. Early and late results in surgical excision of primary cardiac tumors: Our single-institution experience. Turk Gogus Kalp Dama 2018;26:177-82.
Gaies MG, Gurney JG, Yen AH, Napoli ML, Gajarski RJ, Ohye RG, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010;11:234-8.
Becker AE. Primary heart tumors in the pediatric age group: a review of salient pathologic features relevant for clinicians. Pediatr Cardiol 2000;21:317-23.
Freedom RM, Lee KJ, MacDonald C, Taylor G. Selected aspects of cardiac tumors in infancy and childhood. Pediatr Cardiol 2000;21:299-316.
Bielefeld KJ, Moller JH. Cardiac tumors in infants and children: study of 120 operated patients. Pediatr Cardiol 2013;34:125-8.
Black MD, Kadletz M, Smallhorn JF, Freedom RM. Cardiac rhabdomyomas and obstructive left heart disease: histologically but not functionally benign. Ann Thorac Surg 1998;65:1388-90.
Günther T, Schreiber C, Noebauer C, Eicken A, Lange R. Treatment strategies for pediatric patients with primary cardiac and pericardial tumors: a 30-year review. Pediatr Cardiol 2008;29:1071-6.
Nir A, Tajik AJ, Freeman WK, Seward JB, Offord KP, Edwards WD, et al. Tuberous sclerosis and cardiac rhabdomyoma. Am J Cardiol 1995;76:419-21.
Wu KH, Mo XM, Liu YL. Clinical analysis and surgical results of cardiac myxoma in pediatric patients. J Surg Oncol 2009;99:48-50.
Isaacs H Jr. Fetal and neonatal cardiac tumors. Pediatr Cardiol 2004;25:252-73.
Ganame J, D’hooge J, Mertens L. Different deformation patterns in intracardiac tumors. Eur J Echocardiogr 2005;6:461-4.
Thomas-de-Montpréville V, Nottin R, Dulmet E, Serraf A. Heart tumors in children and adults: clinicopathological study of 59 patients from a surgical center. Cardiovasc Pathol 2007;16:22-8.
Kutsal A, Tansal S, Okutan H, Tuncer I. Primary malignant mesenchymoma of the heart. Eur J Cardiothorac Surg 2002;21:124-6.