Treatment Strategies for Primary Tumors of the Heart in Children: A 10-Year Experience

Background: The goal of this study was to determine the optimal treatment strategy for children with primary tumors of the heart.

Methods: We reviewed 88 children with primary heart tumors in our center from January 2004 to December 2013. Operative patients were followed every 6 months in the first postoperative year and then regularly every 12 months; nonoperative patients were followed once a year after diagnosis. Demographic information of imaging, operative details, and postoperative data were obtained from medical records. Statistical analyses were carried out by means of Fisher's exact tests and Student's t test.

Results: Of the 23 patients who underwent surgical removal of the tumors (range, 12 days to 14.4 years; median, 1.3 years), 19 patients had stable postoperative hemodynamics, 4 had low cardiac output, and 2 patients died (mortality, 9%). The follow-up ranged from 6 months to 9 years; 2 patients had tumor recurrence, and 1 patient was lost to follow-up. The rest of the operative patients remained in normal sinus rhythm and had normal cardiac function. The 65 patients treated nonoperatively (range, 1 day to 14.4 years; median, 0.4 years) were followed closely for 1 month to 9.8 years; only 1 patient died (of unknown reasons), 1 patient received a cardiac transplant, and 9 patients were lost to follow-up.

Conclusions: Operative resection is optimal for primary tumors of the heart in patients with obvious symptoms or hemodynamic changes. Rhabdomyomas have the potential for spontaneous regression, and nonoperative follow-up therefore is acceptable even if symptoms appear. Operative risk is greater in younger patients and in patients with cardiac valvular dysfunction.