**2.1 Myxoma**

Three quarters of all primary cardiac tumors are benign and half of them are myxomas. These tumors occur mostly in third decade or later. Myxomas can occur as an isolated tumor in left atrium (the most common site of this tumor)[figure 1] or as familial form (Carney syndrome) which is associated with other manifestations. Most frequently it occurs in left atrium, then in right atrium, right ventricle and left ventricle; it can infrequently involve the valves. It is mostly attached to fossa ovalis via its stalk.

Fig. 1. Parasternal long axis view. A 38 year old man with history of dyspnea. Echocardiography revealed left atrial mass. He underwent cardiac surgery and pathology showed myxoma.

Myxoma has different clinical presentations. These include constitutional symptoms such as fever, weight loss, embolic events and symptoms of valvular obstruction such as the symptoms of mitral valve stenosis (figure 2).

as malignant melanoma, lymphomas, leukaemias and sarcomas. Lymphatics and direct invasion from adjacent organs such as lung and breast cancers or mediastinal lymphomas is

Three quarters of all primary cardiac tumors are benign and half of them are myxomas. These tumors occur mostly in third decade or later. Myxomas can occur as an isolated tumor in left atrium (the most common site of this tumor)[figure 1] or as familial form (Carney syndrome) which is associated with other manifestations. Most frequently it occurs in left atrium, then in right atrium, right ventricle and left ventricle; it can infrequently involve the

Fig. 1. Parasternal long axis view. A 38 year old man with history of dyspnea.

Echocardiography revealed left atrial mass. He underwent cardiac surgery and pathology

Myxoma has different clinical presentations. These include constitutional symptoms such as fever, weight loss, embolic events and symptoms of valvular obstruction such as the

another way of spread (7, 6).

**2.1 Myxoma** 

showed myxoma.

symptoms of mitral valve stenosis (figure 2).

**2. Benign primary cardiac tumors** 

valves. It is mostly attached to fossa ovalis via its stalk.

Fig. 2. A 38 year old man with history of dyspnea. Myxoma can protrude through mitral valve and in M-mode mitral stenosis can be visualized as seen in this Echocardiograph.

Cardiac Tumors 157

Sarcomas are the most common primary malignant tumors and consist of 95% of cases. Any part of heart can be affected and rapid progression of disease is the usual clinical course of

Angiosarcoma is the most common primary malignant cardiac tumor (7). Men are involved more than female with a ratio of 2:1. Its usual location is right atrium and interatrial septum with involvement of pericardium and pericardial effusion [figure 3] (8). Other forms of sarcoma can occur in the left side of the heart and resemble the presentation of myxoma. It

Fig. 3. Large tumor in right atrium with invasion toward interatrial septum and left atrium with pericardial effusion. In a 27 year old man who presented with progressive dyspnea.

Metastatic tumors are 20 to 40 times more common than primary malignant ones with

For the first time the term "melanotic heart" was introduced by William Norris in 1820 (7). However, many cases of malignant melanoma have been described in scientific literature.

prevalence of 6% in post-mortem autopsies in malignant diseases (6).

**3. Malignant primary cardiac tumors** 

this tumor (8).

**3.1 Angiosarcoma** 

has a poor prognosis.

**4. Metastatic cardiac tumors** 

**4.1 Malignant melanoma** 

It has also different shapes as rounded or polypoid with narrow stalk and attachment to interatrial septum or fossa ovalis. The mass is mostly homogenous; however, small scattered area of calcification may be seen. Mobile particles of this tumor describe and predict its tendency for embolic events (8).

Echocardiography provides useful information about the location, size, extension and texture of this tumor, and one should be careful not to miss the multiple myxomas that could be found in other chambers.

Definite treatment for myxoma is total excision of the mass. Follow up echocardiography to rule out recurrence is recommended.
