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Cardiac magnetic resonance imaging (MRI) is an important tool for the diagnosis of cardiac masses. Various cardiac tumors are predisposed to occurring in atrial structures. The aim of this review article is the description of atrial tumors and their morphological features in MRI. In general, cardiac tumors are rare: approximately 0.001 - 0.03 % in autopsy studies. About 75 % of them are benign. The most common cardiac tumor is the myxoma. They are predisposed to occur in the atria and show a characteristically strong hyperintense signal on T 2-wieghted images in MRI. In other sequences a heterogeneous pattern reflects its variable histological appearance. Lipomas exhibit a signal behavior identical to fatty tissue with a typical passive movement in cine imaging. Fibroelastomas are the most common tumors of the cardiac valves. Consisting of avascular fibrous tissue, they often present with hypointense signal intensities. Thrombi attached to their surface can cause severe emboli even in small tumors. Amongst primary cardiac malignancies, sarcomas are most common and favor the atria. Secondary malignancies of the heart are far more common than primary ones (20 - 40 times). In case of known malignancies, approximately 10 % of patients develop cardiac metastasis at the end of their disease. Lymphogenic metastases favor the pericardium, while hematogenic spread prefers the myocardium. Since they are not real atrial tumors, thrombi and anatomical structures of the atria have to be differentiated from other pathologies.

Off pump coronary artery bypass (OPCAB) grafting is still discussed controversially in the cardiac surgical community. Early perioperative results are encouraging. Only few reports have focused on mid-term recurrence of angina and freedoms from death or re-intervention. -107 OPCAB patients (mean age 63 +/- 1 years, 77 male, log EuroScore 5.6 +/- 0.7, number of distal anastomoses 2.0 +/- 0.1), operated on between January 1999 and December 2003, were systematically followed up comparing pre- and post-op NYHA- and CCS-classifications and assessing freedom from death and re-intervention. 52 of 107 patients underwent postoperative angiography or multi-slice computed tomography (MSCT); 6 of the latter 52 patients were symptomatic, 3 with unstable angina, the others underwent follow-up studies having given their informed consent. -The 30 day mortality was 2%. Freedom from death or re-intervention at 5.5 years was 91% and 80%, respectively. Only three patients required re-intervention in an OPCAB-related vessel. CCS classification was 2.8 +/- 0.1 before surgery and 1.8 +/- 0.2 (p0.01) at follow-up (3.3 +/- 0.3 years). NYHA classification was 2.7 +/- 0.1 and 2.2 +/- 0.1 (p0.01), respectively. Out of 107 patients, 52 underwent coronary angiography or MSCT (6 for cardiac symptoms) at a mean follow-up of 2.2 +/- 0.3 years. Left internal thoracic artery was patent in 91%, venous graft patency rate was 83%. -In this small but consecutive OPCAB population with a considerable perioperative risk according to the EuroScore, freedom from death and re-intervention at 5.5 years is acceptable and graft patency rate at 2.2 +/- 0.3 years is in the expected range. Significant reduction in both CCS and NYHA classification indicate sustained clinical improvement at mid-term.