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Of all benign neoplasms of the heart, cardiac myxomas (CM) are found in 50-90% of cases. National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine has experience in surgical treatment of 968 heart tumors. Of these, CM was observed in 868 cases. The aim. To conduct an analysis of the frequency of detection of complicated forms of CM, to present the causes and methods of diagnosis and surgical treatment of these complications. Material and methods. Pathology of the valvular apparatus combined with CM occurred in 70 (8.1%) patients: an isolated lesion of the mitral valve (MV) was observed in 27 (38.6%) patients, concomitant relative insufficiency of the tricuspid valve (TV) was found in 10 (14.3%) cases. Results. During the surgical treatment of valvular pathology, we performed valve replacement in 15 (21.4%) patients (MV in 12, TV in 1, aortic valve [AV] in 1, AV + MV in 1 patient), reconstructive operations with a positive functional effect in 50 (71.4%) patients, and isolated tumor removal from the valve apparatus in 5 (7.1%) cases. Relapses after surgical treatment of CM in our cohort of patients occurred in 1.8% cases. Among patients with sporadic myxomas of the heart, recurrence was observed in 13 cases (1.5%). If the principle of radical removal of CM followed, relapses occurred in 1.3% (10 cases out of 772). In 7 cases of myxoma syndrome, the recurrence rate was 42.5%. Embolic complications of the course of CM were determined in 58 (6.7%) cases. Damage to cerebral vessels was found in 46 (77.9%), embolisms of peripheral vessels in 10 (16.9%), and embolisms of coronary arteries in 2 (5.1%) patients. In 41 patients with CM (4.2%), a significant lesion of the coronary arteries was found, which required surgical intervention. To correct the pathology of the coronary vessels, the following was performed: stenting in 3 cases (7.3%), coronary bypass surgery in 35 (85.4%), dissection of the muscle bridge that narrowed left anterior descending artery in 2 (4.9%), left ventricular aneurysm plastic surgery in 1 case (2.4%). Conclusions. Calcium changes in left atrial myxoma were most often accompanied by mechanical damage to the leaflets and chordal apparatus of the mitral valve. Hyperthermia was a frequent manifestation of CM (56.8%). In isolated cases, the temperature reaction may be associated with the tumor infection process.

Background. The stage 4 mitral stenosis is accompanied by atrial fibrillation which significantly worsens the prognosis due to the possibility of thromboembolic complications. However, sinus rhythm does not exclude the possibility of thrombosis which sometimes requires differential diagnosis with heart tumors. The aim. To present a case of unusual thrombus formation in a patient with significant mitral stenosis on the background of sinus rhythm and describe the specifics of determining indications for surgical intervention. Case report. Female patient K., 42 years old, who was admitted on January 12, 2023 to the National Amosov Institute of Cardiovascular Surgery, had been suffering from rheumatism for the past 20 years. In this case, the clinical course of mitral stenosis could be classified as stage 4, since there were signs of severe heart failure (shortness of breath on light exertion, peripheral edema, right-sided pleuritis, pulmonary thrombosis). However, the patient had sinus rhythm, which is more characteristic of the stage 3 mitral stenosis. The patient underwent mitral valve prosthetic surgery and removal of an unusual thrombus from the pulmonary valve cavity on January 23, 2023. Conclusions. The course of mitral stenosis, despite its thorough study, may have unusual clinical and instrumental manifestations, which requires differential diagnosis with heart tumors and other diseases. In some cases, the mechanism of thrombus formation can be extremely unusual, which can be a subject for discussion by cardiologists.

The aim – to present the features of the clinical manifestations and course of two cases of embolism of the coronary arteries, in which fragments of left atrial (LA) tumors served as the embolic substrate. Materials and methods. This article discusses two cases of embolism with tumor fragments of the coronary arteries. In this case, the neoplasms were located in the left heart. Of particular interest is the fact that the clinical manifestations of embolism varied significantly, from severe pain requiring endovascular intervention, to minor discomfort lasting for several hours, without necessity of the inpatient treatment. Results. It should be noted that in both cases, a tumor lesion of the heart was detected several months after primary manifestation of the disease, namely, embolism of the coronary arteries. Echocardiography study made possible to get a correct diagnosis. In one case it was a routine examination 6 months after stenting of the coronary artery. The reason to perform echocardiography in another case was the result of electrocardiography, showing necrotic changes of the left ventricular posterior wall. In both cases, echocardiographic data prompted immediate surgery of the neoplasms. The structure of neoplasm samples obtained as a result of the surgery confirmed the possibility of coronary artery embolism with tumor fragments. Conclusions. Embolic complications may be a first manifestation of cardiac tumor. Fragmentation of the heart neoplasms may lead to damage of the cerebral and coronary arteries. Embolic complications can occur in young patients. Coronary artery embolism in cardiac tumors is associated with diverse clinical manifestations.

The article describes an unusual course and complex differential diagnosis of fibrotic pericarditis, which imitated a heart tumor at the base of aorta. The key point in the progression of the disease was the appearance of concomitant fungal infection, which led to the emergence of its clinical manifestations. Due to the external compression of the main trunk of the left coronary artery up to 90 %, its stenting was performed. A biopsy followed by histopathological examination, along with other diagnostic methods, allowed to prescribe an adequate treatment for this pathology

Introduction. In the structure of cardiac neoplasms, myxoma accounts for 80–90% of benign heart tumors. The frequency of diagnosis of primary heart tumors (PHT), of which more than 80% are morphologically benign tumors, ranges from 0.09% to 1.9% of the total number of hospitalized patients. The aim of the study is to identify important issues of diagnosis and tactics of the surgical treatment of primary heart tumors. Material and methods. At the In Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine for the period from January 1, 1969 to January 1, 2019, 962 patients operated due to primary cardiac tumors. The myxomas of heart (MH) founded in 856 (89.0%) patients, of which in 752 (87.8%) cases – MH of left atrium (LA). The right atrial myxomas (RA) were diagnosed in 77 (9.0%) cases, MH in the left (LV) and in the right (RV) ventricles each in 8 (0.9%) cases, respectively. Multicentric tumor growth with the damage of two or three chambers of the heart was found in 11 (1.3%) patients. The age of patients with MH was from 3 to 78 years old (the middle age 47.5 ± 3.4), of which 621 (72.6%) were between 31 and 60 years old. Non-myxomic benign tumors were observed in 37 (3.9%) cases, malignant tumors – in 67 (7.0%) cases. Results and discussion. The III and IV functional classes according to the NYHA classification included 311 (36.3%) and 73 (8.5%) patients, respectively, which in these groups often required urgent surgical treatment. Hospital mortality over the past 19 years was 0% in the surgical treatment of MH, namely, 493 operations performed without lethal outcomes. Conclusions. The accepted tactics of emergency diagnosis and surgical intervention ensures the effectiveness of treatment with MH, as evidenced by the data of long-term results: 574 (78.3%) patients assigned to the NYHA functional class I, and 108 (14.8%) patients to NYHA functional class II. Survival rate up to 20 years was 79.8%.

Primary tumors of the heart are presented by different morphological types. One of the rarest forms is a schwannoma of the heart. It consists of the Schwann cells or neurolemmocytes, which produces the myelin constituent of peripheral nerves. Frequency is from 0.02 to 0,056% of all primary tumors. First time it was described in 1972 and it is currently the subject of intense study by clinicians and morphologists, which is associated with the extreme rare diagnostic and peculiarities of the histological structure. Thus far 23 cases of this disease have been reported in the literature, 8 of them located primarily in the right atrium. During the study of this type of tumor in 1920, the Swedish scientist N. Antoni identified two types of tumors depending on the type of cellular architecture (type A and type B). Type A consists of spindle-shaped cells in the form of bundles, and type B consists of polygonal cells with abundant cytoplasm and they are not tightly arranged. Also, in addition to identifying specific cells, the diagnosis of schwannoma can be confirmed due to the strong diffuse staining of the S100 protein. The only method of treatment is surgical correction with the replacement of the tissue deficit with various biological and synthetic materials after tumour resection. If it is impossible to perform a complete excision of the tumor, heart transplant is the only kind of treatment.

This article presents a clinical case of cavernous hemangioma with focal proliferation of endothelium of the left atrium. The tumor was detected in a patient who had complaints of cardiac palpitations and chest pain, occurring during physical effort. During echocardiographic study the pathologic structure in heart resembled myxoma. Intraoperatively the tumor did not differ macroscopically from myxoma too. Microscopically the cavernous hemangioma was diagnosed. Thus, despite echocardiography is the most affordable method for diagnosis of heart primary tumors, it does not allow us to make reliable diagnosis of tumor type. When the tumor of the heart is detected during non-invasive methods of heart visualisation the physicians should be alerted about the possibility of not only the most common type of tumor (myxoma), but also more rare heart tumors such as hemangioma, rabdomioma, lipoma, fibroma and sarcoma

The article presents a clinical case of a rare benign heart neoplasm – a cavernous mitral valve hemangioma. Infiltrative growth of the tumor led to deformation of the valve with the development of mitral insufficiency and its replacement with a mechanical prosthesis.

Berkitt lymphoma as a primary malignant tumor of the heart occurs extremely rarely. By the time of the diagnosis, patients already have regional or distant metastases, which greatly worsens their clinical condition and the prognosis of surgical treatment. Hospital mortality in patients with malignant neoplasms is 25–50 %. The article describes an unusual case of Burkitt's lymphoma with heart involvement in a male of 27 years old. Various diagnostic methods were used to determine the nature of the neoplasm. Subsequent treatment methods resulted in a positive long-term outcome.

Primary angiosarcoma of the heart, constituting 33% of primary heart malignancies in adults, refers to rare diseases with a difficult diagnosis. The article describes the case of primary angiosarcoma of the right atrium, diagnosed posthumously in a patient of 45 years old. The disease debuted in a previously healthy woman 45 years, 2 months before her death. There were episodes of sudden decrease in blood pressure with pain in the chest and short-term loss of consciousness, as well as moderate manifestations of heart failure (hydrothorax, small ascites, hydropericardium, hepatomegaly, leg shunting). The patient died suddenly, a pathologic study revealed an angiosarcoma of the right atrium with invasive growth, accompanied by inferior vena cava stenosis. Angiosarcoma of the heart should be included in a differential diagnosis of patient with pericardial effusion of unspecified genesis, syndromes of vena cava obstruction, unexplained right ventricular failure, syncope with a fall in blood pressure, especially in middle-aged patients.

The objective is to describe a rare clinical case of Behcet’s disease with right atrium thrombosis and suspicion of a heart tumor.Materials and methods. Woman, 34 years old, in December of 2015 sought medical help at a local outpatient facility, and then from a gynecologist at the Central Clinical Hospital of Civil Aviation due to painful ulcers in the genital area and fever. Her state was considered a nonherpetic infection, antiviral therapy was administered. Ulcers in the oral cavity and genital area were first diagnosed in August of 2015. In April of 2016, aphthous stomatitis developed. The patient also complained of oral ulcers, fatigue, body temperature increase up to subfebrile values, slight shortness of breath during physical activity, discomfort in the upper part of the stomach. Ultrasound of the abdominal organs and heart had shown a mass resembling a thrombus in the hepatic vein and inferior vena cava which reached the right atrium. The size of the non-mobile mass in the atrium was 38 × 25 mm. The patient was hospitalized in a cardiological department.The following examinations were performed: standard laboratory tests, electrocardiogram, repeat ultrasound of the abdominal organs and heart, X-ray of the chest, oncocytomarker tests, magnetic resonance imaging (MRI), spiral computed tomography (SCT) with contrast of the pelvic and abdominal organs.Subsequently, due to uncertain diagnosis the patient was consulted at the A.N. Bakoulev Scientific Center for Cardiovascular Surgery, N.N. Blokhin Russian Cancer Research Center, V.A. Nasonova Research Institute of Rheumatology.Results. Ultrasound of the heart and abdominal organs had shown a large mass in the inferior vena cava extending to the right atrium, which lead to a suspicion of a myxoma or thrombosis. After MRI of the heart and abdominal organs, an infectious thrombus in the heart and inferior vena cava was suggested. SCT with contrast of the pelvic and abdominal organs, oncocytomarker tests didn’t show any pathology. The combination of aphtous ulcers of the mouth and genitalia and inferior vena cava thrombosis allowed to suspect the Behcet’s disease. This diagnosis was confirmed at the V.A. Nasonova Research Institute of Rheumatology. Prescribed immunosuppressive therapy (meripred, azathioprine, colchicine), which is still ongoing, led to a decrease in inflammatory activity (С-reactive protein), reduction of the thrombus in the right atrium and inferior vena cava. Currently, the patient continues to receive the prescribed immunosuppressive therapy. No complaints, feeling healthy, working. The patient remains under the care of physicians.Conclusion. This clinical case demonstrates diagnostic complications of detection of masses in the heart which can represent a tumor or a thrombus. In the described case, diagnosis of the Behcet’s disease was facilitated by typical aphtous ulcers of the mucosa of the mouth and genitalia and development of vasculitis with subsequent thrombosis of the inferior vena cava and right atrium.

Analysis of intracardiac space-occupying lesions, surgically removed at V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs over 25 years (in the period from 1992 until 2016) was carried out. During that period 134 patients underwent surgery. Preoperative clinical diagnosis before surgery was heart myxoma. From 134 patients, only in 115 (85.8%) patients the removed intracardiac lesions were myxomas: left atrium – 103 (89.7%) patients, right atrium – 10 (8.7%), right ventricle – 2 (1.8%) and mitral valve – 1 (0.8%) patient. 9 patients had thrombi in the heart, 10 patients had not myxomas, but other benign and malignant heart tumors. This article presents macroscopic, histolological and ultrastructural characteristic of cardiac myxomas. Recurrence of the left atrium myxoma occurred in 2 patients. They were re-operated in four and six years after the first removal of myxoma. 2 patients died during hospital period. One patient with atherosclerosis of the coronary arteries as a concurrent disease died of embolization of the stent coronary artery with myxoma particles with the development of acute heart failure. Death of the 2nd patient was not directly related to the surgery, and was due to the acute heart failure as well in connection with the presence of concurrent disease, coronary heart disease.

Aim: To represent a case report of extensive left atrial myxoma removal with permanent pacemaker implantation. Methods: A 56-year old female patient admitted to the Bakulev Center of Cardiovascular Surgery with cardiac evaluation. She noted progressive chest pain associated with dyspnea and fatigue. After physical examination, transthoracic echocardiography and other methods of evolution confirmed the diagnosis: Tumor of the left atrium. Left atrial dilatation. Left ventricle hypertrophy. Arterial hypertension 2 stage of high risk. Circulatory failure 2 stage (by Strazhesko-Vasilenko), functional class II by NYHA. The huge tumor was successfully excised with closure of atrial septal defect by patch. Results: Transthoracic echocardiography in postoperative period showed a normal left and right ventricular function and no residual shunts. The presence of conduction abnormalities in early postoperative period predicted the need for permanent pacemaker implantation. Conclusions: It must be noted rare occurrence of a huge tumor (myxoma) filling left atrium. Large left atrial tumor is approached by biatrial incision with further excision. It is believed that the case can be beneficial in huge cardiac tumors management. Early detection and surgical treatment of heart tumors can reduce the risk of heart failure, systemic embolization, syncope and sudden cardiac death.

The authors present a 57-year-old patient with synchronous left atrial myxoma and gastric cancer undergoing staged treatment. Distal gastrectomy with gastroduodenostomy at the first stage was followed by resection of the left atrial myxoma after 22 days. Postoperative period was uneventful after both interventions. The follow-up examination revealed favorable clinical status and no cancer progression.