Improved Surgical Approach to Cardiac Tumors with lntraoperative Two-dimensional Echocardiography*

Lntraoperative two-dimensional echocardiography allows visualization of cardiac anatomy and function not possible by other techniques. Although preoperative evaluation by noninvasive methods is usually adequate for diagnosis of cardiac tumors, two-dimensional echocardiography can be beneficial intraoperatively. Intraoperative echocardiography provides an accurate evaluation of cardiac anatomy, extent of tumor invasion, valvular function and the possible presence of intracardiac communications. Importantly, following tumor resection and a complex operative reconstructive procedure, the echocardiogram can confirm complete intracardiac tumor excision, evaluate post-repair ventricular function, and exclude an intracardiac communication or valvular insufficiency. I ntracardiac tumors are unusual, and often misdiagnosed. Clinically, they can masquerade as valvular or myocardial disease or present as a major catastrophic thromboembolic event.12 Importantly, successful surgical removal of certain tumor types, particularly myxomas, carries a good prognosis.3 Preoperative evaluation of intracardiac masses is primarily done by two-dimensional echocardiography since cardiac catheterization may be hazardous due to the friable nature of the mass.4 However, the extent of cardiac invasion and the potential involvement of contiguous valves may not be fully appreciated.5 Therefore, the intraoperative evaluation of the extent of intraand extracardiac involvement of the malignancy is important. Intraoperative two-dimensional echocardiography has recently been applied to evaluate ventricular function,6 valvular operations’ and myocardial perfusion.8 This technique has proven to be a safe and effective method for evaluating cardiac anatomy and function which otherwise can be only indirectly assessed. Moreover, it can be utilized prior to and immediately following the operative procedure. We applied intraoperative echocardiography in the operations of two patients with intracardiac masses which proved valuable in delineating the precise location and extent of tumor, identifying intracardiac shunts, and assessing the operative procedure prior to closure of the chest wall.