Abordagem diagnóstica e terapêutica de tumores cardíacos: revisão narrativa

Abstract

Introduction: Cardiovascular diseases remain the main global cause of mortality and disability. Cardiac tumors are rare and show wide epidemiological variation, with benign primary lesions being the most prevalent. There is increasing diagnostic incidence due to advances in imaging techniques, which allow differentiation from pseudotumoral lesions such as intramural thrombi. For this reason, the study sought to synthesize recent evidence on diagnosis and therapeutic strategies for the main tumor types, highlighting existing gaps in the literature. Methods: Narrative review with a PubMed search for review articles using the descriptors “cardiac tumors” OR “myxoma” OR “papillary fibroelastoma” OR “cardiac rhabdomyoma” OR “cardiac angiosarcoma” OR “cardiac metastasis.” A total of 188 articles from the initial search and 76 from references were screened, with 93 reviews included. Results and discussion: Myxomas and papillary fibroelastomas are the most frequent benign tumors, predominate in atria, and are associated with embolic risk. Rhabdomyomas are mainly pediatric tumors, strongly associated with the tuberous sclerosis complex and prone to spontaneous regression. Among primary malignant neoplasms, angiosarcomas stand out as infiltrative tumors with early metastases. Cardiac metastases may originate from virtually any primary site, present heterogeneously, and predominantly affect the pericardium. Echocardiography is the initial exam of choice for evaluating cardiac tumors, complemented by computed tomography or magnetic resonance imaging for better structural characterization. The preferential therapy is complete surgical resection; however, the strategy must be individualized, with possible use of chemotherapy, radiotherapy, targeted therapy, and immunotherapies depending on tumor type and the patient's clinical condition. Conclusion: Physicians of any specialty should recognize signs that justify the investigation of cardiac masses. There is a noted scarcity in the literature regarding diagnostic and therapeutic approaches for these tumors.