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Concurrent valvular pathology is a complication of cardiac myxoma leading to hemodynamic disturbances and difficulties in differential diagnostics. Treatment of concurrent valvular pathology should be referred to the concept of hemodynamic radicality of a surgical treatment of cardiac tumors. This paper describes a clinical case of giant left atrial myxoma with mitral valve involvement and coexisting coronary artery disease. Damaged mitral valve anterior cusp with mitral regurgitation was discovered only during surgery after the myxoma had been removed. The condition hasn’t been recognized at transesophageal echocardiography or computed tomography. Undoubtedly, mitral valve regurgitation and cusp damage were tricky to determine due to large size of the tumor and its proximity to the damaged cusp. Moreover, the tumor mass held the damaged cusp in place preventing the development of severe regurgitation.

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%.

The aim – to determine the features of surgical treatment of the malignant heart tumors, aimed at their most radical removal. Materials and methods. At the M.M. Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine, during the period 1970–2018 66 patients with malignant neoplasms of the heart of various types and localization were observed, which accounted 6.9 % of the total number of patients with heart tumors (n = 939). Results. Hospital mortality during the surgical treatment was 19.7 % (13 patients). Among 66 operations, 55 (83.3 %) were performed using artificial blood circulation, including 21 (3.8 %) conditionally radical cardiac surgeries with good hemodynamic effect. Conclusions. To achieve the conditional radicalism of the surgery and the maximum hemodynamic effect, it is necessary to use advanced techniques for reconstructing damaged cardiac structures in combination with active detoxification therapy and urgent chemotherapy.

The article presents an unusual case of a metastatic lesion of the right ventricle with malignant neoplasm. Its nature and size was definitively determined during the operation. The surgical treatment of this lesion by valve-preserving operation on the tricuspid valve is discussed. Since 1970, surgical treatment of 62 patients with various types and localization of malignant heart tumors was performed, corresponding to 6.8 % of 912 patients with cardiac tumors. This case is an unusual example of secondary damage to the malignant tumor of the right ventricle. Its primary focus was seminoma (low-grade embryonic G3 cancer). Metastatic malignant tumors of the heart affect its walls, but may also spread to valve structures, requiring correction of valvular lesions. During surgical removal of the tumor it is necessary, as far as possible, to preserve valvular and sub-valvular structures in order to avoid valve prosthetics.