Tumors of the heart. Incidence and clinical importance of cardiac tumors in Japan and operative technique for large left atrial tumors.

In 1986, a total of 18 430 open-heart procedures was performed in Japan. Whereas surgery of congenital heart disease amounted to 46% of all operations, cardiac tumors caused only 0.8% (148 cases). The results of an investigation based on data from 9 Japanese institutes over a period of 5 years show that myxomas are the most frequent tumors of the heart (74 out of 89 cases). Among 89 cardiac tumors there were 6 malignant neoplasms. More females were affected than male patients. Most of the myxomas were localized in the left atrium (66 out of 74). The majority of the myxomas originated from the atrial septum, two myxomas derived from atrio-ventricular valves. Inflow and outflow obstruction, valvular dysfunction and arrhythmias were the most common symptoms of cardiac tumors. In 88 patients resection of the tumor could be performed, in 4 cases combined with mitral valve replacement and in one case mitral valvuloplasty. In one patient, only a tumor biopsy was possible. Reoperation for recurrent myxoma had to be carried out in 4 patients after an interval of 1-6 years. In the case of a large left atrial tumor the circular incision of the biatrium is preferred by our group. This large approach facilitates the removal of the tumor, enables the repair of the left atrial posterior wall and atrial septum as well as the surgery of the mitral valve. If necessary, this surgical technique can easily be switched to cardiac autotransplantation. With regard to new operative procedures we are convinced that surgical intervention for cardiac tumors can be applied more widely in future.