Surgical Therapy
There are no consensus guidelines regarding PFE treatment. Due to tumor embolization risk, many groups advocate urgent resection in asymptomatic, low risk patients with left sided lesions.8-10, 24-27 It is generally agreed upon that symptomatic patients should be offered surgery. Surgical approaches to PFE are driven by tumor location and additional concomitant surgical procedures that may be required. For solitary tumors without valvular dysfunction, simple excision is the most common resection technique.26 Excision and valve repair/replacement has also been described with good results.
Median sternotomy historically was the most popular surgical exposure. Increasing use of minimally invasive cardiac surgery however has led to tumor removal using mini thoracotomy/Heart Port access techniques (Table 1). Intracavitary ventricular-based tumors not readily visible through surgical incisions have been resected using cardioscopy assistance (Table 2). 16-26 Cardioscopy must be performed carefully to avoid injuring the intrinsic structure of the heart.
Tumor resection principles include: complete tumor removal with preservation of cardiac structure. Cardiopulmonary bypass support is required. Procedures have been performed with and without electromechanical arrest. Recurrence rate following surgical resection is between 0 and 4%.10, 11, 28 Recurrent disease management is driven by tumor size, symptoms, and patient performance status.