Letter:
To the editor
We have read with great sincerity the article, “Surgical treatment of
primary cardiac tumors in the contemporary era: A single Centre
analysis,” by Matteo Matteucci MD et al.1 It was a
pleasure for us to read the concisely written article, and we
congratulate the authors for their excellent efforts, but we have few
concerns regarding the article which we would like to mention here.
The authors did not highlight some significant non-myxoma tumors like
fibroma, hemangioma, and pheochromocytoma.2 These
tumors do not have a good prognosis like myxoma, so the percentage of
morbidity and mortality after resection of primary tumors could vary, as
mentioned in the article. Moreover, the authors mentioned cerebral
embolic symptoms like a stroke but did not highlight peripheral embolic
events and constitutional symptoms.(2,5) Likewise,
talking about the final message of the article, which states that
“Surgical resection of benign tumors is safe and complete excision
results in no recurrence especially for Myxoma” But the Authors did not
mention about Myxoma-Myxofibrosarcoma transformations that occur with a
frequency of 1.3%.3 This finding could change the
outcomes of the study. Third, the authors mentioned the relation of
mortality with tumor Histology, but there was no reference of
characteristics such as Symptomology, Age, and Gender. This article
states that Surgical resection of all benign tumors have a reasonable
survival rate. However, some research shows that only resection of
myxomas has good survival characteristics compared to other benign
histological variants whose results vary significantly in different age
or gender groups. Moreover, resectioning fibromas, papillary
fibroelastosis, and lipomas have poor survival
characteristics.3 The survival rate after resection of
these tumors varies in different age groups as these tumors have a poor
prognosis at a younger age.
Fourth, the authors did not highlight resection of primary malignant
tumors, most commonly angiosarcoma.4 Although these
tumors have a very poor prognosis, research shows that patients with a
radical resection at first surgery had more prolonged survival than
patients with partial resection. The mean survival is better in Men than
in Women.
Lastly, the authors did not explain the reason for early and late
morbidity and mortality. At the same time, some researches proved that
early morbidity and mortality after tumor resection was due to
arrhythmias, heart block, and pericardial effusion, and late morbidity
and mortality was due to arrhythmia and heart block. In operation
techniques, the authors mentioned right and left atriotomy but did not
highlight pulmonary lobectomy in some operating
techniques.5 These new findings should be an important
concern as some benign histological variants of myxoma have poor
prognosis so it should not be generalized that all primary cardiac
tumors have safe results.