AUTHOR=Qian Tao , Wu Zhongshi , Yang Yifeng , Xie Li , Yin Ni , Lu Ting , Huang Can , Yang Hui 

TITLE=Surgery for Primary Cardiac Tumors in Children: Successful Management of Large Fibromas

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.808394

DOI=10.3389/fcvm.2022.808394

ISSN=2297-055X

ABSTRACT=Background: Pediatric primary cardiac tumors (PCT) are rare. Its clinical features and prognoses are not well defined. The management of asymptomatic patients with cardiac fibromas remains controversial.
Objective: We aimed to examine our experience in surgical resection of pediatric PCT, with specific focuses on the management of large fibromas.
Methods: This study included all children underwent surgical resection of PCT in our institution between December 2008 to June 2021. Last follow-up was performed between June 1st and August 26th, 2021. Kaplan-Meier method was used to estimate the postoperative survival, freedom from reoperation, and event-free survival, as well as related risk factors. The tumor volume and volume index (volume divided by body surface area) was measured for cardiac fibromas.
Results: Of the 39 patients with median operative age of 9.5 (IQR:1.2-16.5) years, 35 (89.7%) had benign tumors (fibromas for 15, myxomas for 13, others for 7). The length and volume of fibromas were independent with age and symptoms (Ps>0.05). The fibroma volume index was negative correlated with age (P=0.039), with mean value of 105±70 ml/m2. Of the 15 patients with fibromas, 5 were asymptomatic, 4 received partial resection, 4 required transmural resection, and 4 presented postoperative left ventricular (LV) dysfunction (ejection fraction <50%). During the median follow-up period of 3.1 years and maximum of 12.5 years, adverse events included 2 early and 1late death, 4 reoperations, 4 tumor recurrences, and 1 LV dysfunction lasting over one year. The 8-year survival, freedom from reoperation, and event-free survival rates were 90.4%, 81.8%, and 64.2%, respectively. Malignant tumor (P<0.001) was associated with more adverse events. Transmural resection (P=0.022) and larger tumor volume index than LV end-diastolic volume (P=0.046) were risk factors for LV dysfunction following fibromas resection.
Conclusions: Pediatric surgery for PCT can be performed with low mortalities and few adverse events. The size of cardiac fibroma in children relatively decreases with the increase of age. Larger tumor volume index than LV end-diastolic volume index and transmural tumor resection predicts postoperative LV dysfunction.