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Ann Thorac Surg 2003;75:1363-1364
© 2003 The Society of Thoracic Surgeons

Correspondence

Endomyocardial biopsy of cardiac neoplastic involvement

John P. Veinot, MD, FRCPC

Department of Laboratory Medicine, Room 103, Ottawa Hospital, Civic Campus, 1053 Carling Ave, Ottawa, Ontario, Canada K1Y 4E9

e-mail: jpveinot{at}ottawahospital.on.ca

To the Editor:

Hardikar and colleagues [1] have recently described a patient with cardiac involvement by relapsed acute lymphoblastic leukemia. The right atrial mass was surgically excised owing to right heart dysfunction. The authors emphasize the importance of early diagnosis for potential aggressive therapy.

For earlier diagnosis it is worth emphasizing that intracardiac masses may also be diagnosed preoperatively using endomyocardial biopsy [2–5]. This procedure is well suited for biopsy of right-sided neoplasms, and with transseptal puncture, left atrial tumors may be diagnosed [2, 3]. Such "closed" biopsy allows early diagnosis without sternotomy.

In the case of aggressive neoplasms, or cardiac involvement by metastatic tumor, it may be appropriate only to treat medically or be conservative. The critically ill patient may thus be spared anesthesia and a sternotomy.

In the case of lymphoid and hematological neoplasms the diagnosis can be made and tissue for flow cytometry and cell markers can be obtained [4, 5]. With inoperable lymphoid tumors that may be treated with monoclonal antibody therapy such as Rituxan (antibody to CD20—a marker of B cells) such determination of cell markers and accurate diagnosis may be very valuable for treatment decisions.

As the paper mentions, immunocompromised patients may also have fungal infections, which may be assessed. It is important to remember that infective endocarditis may be atypical in such patients. In addition to valvular masses, mural or endocardial masses are also described in immunocompromised patients.

Finally, in addition to tumor diagnosis myocardial cardiotoxicity due to prior chemotherapy, including anthracycline drugs, may be assessed and graded by heart biopsy [2]. If the patient requires additional chemotherapy, this information is also useful for treatment planning.

References

  1. Hardikar A., Shekar P., Stubberfield J., Craddock D.R., Bignold L.P. Cardiac involvement in a case of acute lymphoblastic leukemia. Ann Thorac Surg 2002;73:1310-1312.[Abstract/Free Full Text]
  2. Veinot J.P. Diagnostic endomyocardial biopsy pathology: secondary myocardial diseases and other clinical indications—a review. Can J Cardiol 2002;18:287-296.[Medline]
  3. Chan K.L., Veinot J., Leach A., Bedard P., Smith S., Marquis J.F. Diagnosis of left atrial sarcoma by transvenous endocardial biopsy. Can J Cardiol 2001;17:206-208.[Medline]
  4. Alter P., Grimm W., Tontsch D., Maisch B. Diagnosis of primary cardiac lymphoma by endomyocardial biopsy. Am J Med 2001;110:593-594.[Medline]
  5. Burling F., Devlin G., Heald S. Primary cardiac lymphoma diagnosed with transesophageal echocardiography-guided endomyocardial biopsy. Circulation 2000;101:E179-181.[Medline]




This Article
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