Benign primary cardiac tumours in a tertiary centre: 10-year casuistic of presentation, imaging workflow and outcomes

Background

Although benign primary cardiac tumours are rare, they carry clinically relevant embolic risk and potential haemodynamic compromise. Contemporary real-world descriptions can inform practical diagnostic pathways in cardiology.

Purpose

To describe baseline characteristics, clinical presentation, echocardiographic phenotype, imaging workup, treatment and outcomes of benign primary cardiac tumours in a tertiary centre over the last 10 years.

Methods

Single-centre retrospective 10-year registry including adults with benign primary cardiac tumours (N=28). All patients underwent surgical resection. Variables included demographics and comorbidities, mode of detection, symptoms and "hard events" (embolic events, arrhythmias), echocardiographic features (location, maximal diameter, mobility, pedicle, obstruction, pericardial effusion), additional imaging (TEE/CMR/CT), and follow-up outcomes (recurrence, mortality). Results are reported as median (IQR) or n (%).

Results

Median age was 63.0 years (45.0–70.0), and 10/28 (35.7%) were male. Hypertension was present in 12/28 (42.9%), diabetes in 4/28 (14.3%), coronary artery disease in 5/28 (17.9%), and prior atrial fibrillation in 1/28 (3.6%). Most patients were NYHA I–II (27/28). Detection occurred mainly in outpatient pathways (15/28), emergency setting (6/28) or as incidental findings (6/28); one case had missing categorisation. Patients were asymptomatic in 9/28 (32.1%), embolic events occurred in 7/28 (25.0%), and arrhythmias in 4/28 (14.3%).

Histology comprised myxoma (20/28) and papillary fibroelastoma (8/28). Tumours were most frequently located in the left atrium (18/28), followed by valvular location (5/28). Median maximal diameter was 24.0 mm (15.0–41.0). Obstruction was present in 5/28 (17.9%). No pericardial effusions were recorded. TEE was performed in 15/28 (53.6%), CMR in 2/28 (7.1%), and CT in 3/28 (10.7%). Complete resection (R0) was achieved in all cases, with no documented recurrences. Two deaths occurred during follow-up (7.1%). Median follow-up (final diagnosis to last contact) was 10.3 months (5.2–28.2).

Conclusions

Over the last decade, benign primary cardiac tumours in our tertiary centre were dominated by myxoma and papillary fibroelastoma, with a substantial burden of embolic presentation. TTE and TEE were the principal diagnostic tools, and outcomes were favourable with no documented recurrence. Despite benign histology, the observed embolic rate underscores the need for streamlined diagnostic-to-treatment pathways to mitigate preventable complications.