IMPROVED ASSESSMENT OF CARDIAC TUMORS WITH REAL-TIME THREE-DIMENSIONAL ECHOCARDIOGRAPHY

Purpose: Real-time three-dimensional echocardiography (RT-3D echo) is a new modality of echocardiography that allows a better recognition and spatial localization of cardiac structures. We sought to evaluate the potential interest of RT-3D echo in the assessment of cardiac tumors.

Methods and Materials: Eighteen patients (52±16 years, 7 males) presenting with echocardiographic features of cardiac tumors were prospectively studied using 2D echocardiography, RT-3D echo (Sonos Agilent 7500, Philips), and transoesophageal echocardiography when suitable. Spatial localization and morphology, the site of attachment as well as the relationships with cardiac structures were particularly assessed. All echocardiographic data were stored to allow a late analysis.

Results: Twelve patients had echocardiographic features of a primitive cardiac tumor and 5 patients of a secondary cardiac tumor. In one case echocardiography did not allow classification of the tumor. RT-3D echo was able to study the tumor in17 patients (94%); in 1 case the tumor was not visualized with 3D echo. In 13 patients histologic analysis of the tumor was obtained after either surgical removal or biopsy. The diagnostic accuracy of RT-3D echo was 85% (11/13). In all but 1 case, benign tumors had a more homogeneous appearance and a lower echogenicity compared with malignant tumors. Primitive cardiac tumors were fibroelastoma in 3 patients (mitral: 2, aortic: 1) and myxoma in 4 patients (right atrium: 1, left atrium: 3). The alleged diagnosis of the 4 remaining patients were myxoma in 2 patients, and fibroelastoma in 2 patients. The site of attachment of the mass was more precisely identified with RT-3D echo in several patients. RT-3D echo was particularly useful in the definition of the site of attachment in 2 patients with tumors developed on the sub-valvular mitral apparatus. Spatial localization of 1 subvalvular fibroelastoma allowed removal through an aortic valve approach. Secondary tumors were carcinod (1 pt), hepatoblastoma (1 pt), carcinoma epidermocde (1 pt), fibrosarcoma (1 pt), and benign tumor in 1 case. RT-3D echo was particularly useful to define either the site of attachment or the relationships with neighboring cardiac structures in 2 alleged malignant tumors allowing surgical removal of the cardiac invading mass.

Conclusions: In our experience, RT-3D echo in conjunction with 2D echo provided an accurate diagnosis of cardiac tumors. RT-3D echo yielded important additional information about spatial localization, improving the operative planning of cardiac tumors. Three-dimensional echocardiography might become a performing imaging modality to study cardiac masses as it provides a complete display and allows accurate determination of size, shape and localization