Primary cardiac malignancies are rare tumors that are difficult to diagnose clinically. Different primary cardiac malignancies may have different clinical, morphologic, and radiologic features and intracardiac locations. Angiosarcoma is the most common primary cardiac malignancy. It tends to occur in the right atrium and involve the pericardium. Because of its tendency to hemorrhage, angiosarcoma often demonstrates areas of increased signal intensity with T1-weighted sequences. Undifferentiated sarcomas typically occur in the left atrium and have variable epidemiologic and radiologic features. Rhabdomyosarcoma is the most common primary cardiac malignancy in children and is more likely than other primary cardiac sarcomas to involve the valves. Primary cardiac osteogenic sarcoma almost always occurs in the left atrium and frequently demonstrates calcification. Certain features (eg, broad base of attachment, origin at a site other than the atrial septum) help differentiate this tumor from left atrial myxoma. Leiomyosarcoma favors the left atrium and tends to invade the pulmonary veins and mitral valve. Fibrosarcoma also tends to occur in the left atrium and is often necrotic. Liposarcoma is very rare and usually manifests as a large, infiltrating mass. Foci of macroscopic fat are occasionally seen. Primary cardiac lymphoma occurs more commonly in immunocompromised patients, frequently involves the pericardium, and, unlike other primary cardiac malignancies, may respond to chemotherapy. The advent of cross-sectional imaging has allowed earlier detection of primary cardiac malignancies as well as more accurate diagnosis and characterization.

CT and MR Imaging of Primary Cardiac Malignancies

Endomyocardial biopsy (EMB) is widely used for surveillance of cardiac allograft rejection and for the diagnosis of unexplained ventricular dysfunction. Typically, EMB is performed through the jugular or femoral veins and is associated with a serious acute complication rate of less than 1% using current flexible bioptomes. Although it is accepted that EMB should be used to monitor for rejection after transplant, use of EMB for the diagnosis of various myocardial diseases is controversial. Diagnosis of myocardial disease in the nontransplant recipient is often successful via noninvasive investigations including laboratory evaluation; echocardiography, nuclear studies, and magnetic resonance imaging can yield specific diagnoses in the absence of invasive EMB. Therefore, use of the technique is patient specific and depends on the potential prognostic and treatment information gained by establishing a pathologic diagnosis beyond noninvasive testing.

https://www.mayoclinicproceedings.org/article/S0025-6196(11)65199-9/pdf

Current status of endomyocardial biopsy.

Percutaneous balloon mitral valvuloplasty by the Inoue technique: A multicenter study of 4832 patients in China

Doppler echocardiography plays an important role in the evaluation of patients with prosthetic valves. The evaluation of flow velocities across prosthetic valves is more complicated compared with native valves, and flow velocities are specific for various types, positions, and sizes of prostheses. Because all prosthetic valves are at least mildly stenotic and a significant proportion is regurgitant, information regarding normally functioning prosthetic valves is important. Eighteen studies resulting in data on 1105 patients with normally functioning prosthetic valves were reviewed. Significant differences among the various types and sizes of prosthetic valves were found in both the aortic and mitral positions. The results are summarized in tables and figures that can be used for reference in a clinical laboratory.

Normal Values of Prosthetic Valve Doppler Echocardiographic Parameters: A Review

Impaired coronary vasodilator reserve in the immediate postcoronary angioplasty period: analysis of coronary artery flow velocity indexes and regional cardiac venous efflux.

Inoue pioneered the mitral balloon valvotomy technique using his homemade balloon catheter as a nonsurgical therapeutic alternative to the surgical treatment of mitral stenosis. 1 Because Inoue's balloon catheter was not commercially available at the time, Zaibag et al 2 developed the principal of the double balloon technique. 12 The double balloon technique has prevailed to date since the mitral valve areas achieved are excellent and are maintained at long-term follow-up. 2–4 Although the mechanism of mitral valve dilatation for both the Inoue and the double balloon technique are similar, 1–5 i.e., commissural splitting, no comparative clinical data have been reported. Previous published series include noncomparable groups of patients, with different ages and particularly different mitral valve and subvalvular anatomy. 1–4 We selected a homogenous, young population of patients with severe rheumatic mitral stenosis; both groups of patients had comparable mitral valve and subvalvular anatomy and age. The objective of the study was to compare the mitral valve areas and the total procedure times achieved, using the 2 different techniques.

Comparison of mitral valve area results of balloon mitral valvotomy using the Inoue and double balloon techniques.

Endomyocardial fibrosis: report of eight cases.

Percutaneous mitral valvotomy with the Inoue balloon catheter in children and adults: immediate results and early follow-up.

Twenty-four patients with porcine bioprostheses in the mitral position were studied by Doppler echocardiography followed by cardiac catheterization within 24 hours. Doppler mean diastolic mitral valve gradient was calculated by a 3-point method and mitral valve area was determined by the pressure half-time method. Data from Doppler echocardiography and cardiac catheterization were compared. There was a strong correlation between Doppler echocardiography and catheterization-determined mean diastolic gradient: r = 0.9, standard error of estimate (SEE) = 1.4 mm/Hg (regression equation y = 0.63x + 1.41), p less than 0.001. There was also a strong correlation between Doppler echocardiography and catheterization-determined mitral valve area: r = 0.86, SEE = 0.18 cm2 (regression equation y = 0.64x + 0.52), p less than 0.001. Fourteen patients whose valvular function was considered normal by clinical evaluation had Doppler-calculated mean diastolic gradients of 4.5 to 9.5 mm Hg (mean 6.5 +/- 1.4); the Doppler-determined valve area was 1.15 to 2.0 cm2 (mean 1.54 +/- 0.3). Ten patients had a malfunctioning bioprosthesis, 7 had severe mitral regurgitation and 3 had stenosis. Valvular malfunction in all 10 patients was detected by Doppler echocardiography and confirmed by catheterization and angiocardiography. Nine patients underwent reoperation. Doppler hemodynamic evaluation of porcine bioprostheses in the mitral position provided noninvasive information comparable to that obtained by cardiac catheterization.

Hemodynamic evaluation of porcine bioprostheses in the mitral position by doppler echocardiography

Between July 1985 and July 1987, 18 consecutive adult patients with congenital pulmonary stenosis underwent pulmonary balloon valvuloplasty (PBV). There were 11 males and 7 females, aged 15–45 years (mean 25). A double balloon technique was used in 14 patients and a single balloon in four. The size of the balloon used was 0.9 to 1.4 times the size of the pulmonary annulus. Eleven patients were restudied by repeat cardiac catheterization 6 months later. Student's t-test was used for comparison of data. Right ventricular (R V) systolic pressure before dilatation ranged from 84 to 180 (mean 123 ± 28.3) mmHg and the right ventricular to pulmonary artery (PA) peak systolic gradient ranged from 60 to 165 (mean 105 ± 30.2) mmHg. Immediately after dilatation, the RVsystolic pressure dropped to 30–80 (mean 53 ± 14.2) mmHg (P < 0.001). RV to PA peak systolic gradient dropped to 10–57 (mean 32 ± 14.2) mmHg (P < 0.001). A restudy of 11 patients 6 months later showed a further drop of RV systolic pressure to 35–65 (mean 49 ± 11.3) mmHg (P < 0.05). RV to PA peak systolic gradient continued to drop to 10–48 (mean 26 ± 11.3) mmHg (P < 0.01). Cardiac index improved from 2.68 ± 0.73 to 3.03 ± 0.40 L/min/m2, P < 0.05. No complication was noted apart from either sinus bradycardia or extrasystole in a few patients. It was noted that balloon to annulus ratios of 1.1 to 1.4 produced sustained relief of the pulmonary valve stenosis. We concluded that PBV is the treatment of choice for congenital pulmonary stenosis. It reduced the hospital stay to 2 days and avoids the ri±k of open heart surgery. (J Interven Cardiol 1988:1:1)

Late Results of Pulmonary Balloon Valvuloplasty in Adults Using Double Balloon Technique

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