Ventricular response to atrial fibrillation.

The result of the management of the seven cases of cardiac tumors reported by Bini et al. (I) was quite discouraging as only one child survived 3 months. In a recent review of cardiac tumors reported in the English language between 1972 and 1977 (2), I found 47 reported pediatric cases with a survival rate of more than 6 months in 55% of the cases. Forty-four of these tumors were benign with a survival rate of 57%. The survival rate increased significantly if the diagnosis of cardiac tumor was made preoperatively. The reason the survival rate was so low in the series of Bini et al. is probably that their cases were unusually difficult, perhaps because they report from a sophisticated referral center where only the worst cases may be referred. In the seven cases, six tumors were benign, and only one of the patients survived 3 months. Four of the tumors were rhabdomyomas, which appear to have been unusually severe, because all four were associated with tuberous sclerosis. Of the 23 reported rhabdomyoma cases between 1972 and 1977, tuberous sclerosis was present in only approximately 50%. In a less selective case series than that presented from Birmingham, Alabama, the prognosis for infants and children with cardiac tumors appears to be better than that reflected in the article by Bini et al. In the same issue of lACC, Martin and Boak (3) claim that the diagnosis of cardiac tumors is usually made postmortem. In our review of 263 cases of cardiac tumor reported in 1972 to 1977, 205 (78%) had a preoperative diagnosis that greatly improved the prognosis.