Primary malignant cardiac tumors: Surgical results | Revista Portuguesa de Cardiologia (English edition)

array:25 ["pii" => "S2174204916000611" "issn" => "21742049" "doi" => "10.1016/j.repce.2016.03.003" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "769" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2016;35:199-204" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2226 "formatos" => array:3 [ "EPUB" => 145 "HTML" => 1610 "PDF" => 471 ] ] "Traduccion" => array:1 [ "pt" => array:20 [ "pii" => "S0870255116000123" "issn" => "08702551" "doi" => "10.1016/j.repc.2015.11.005" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "769" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2016;35:199-204" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3247 "formatos" => array:3 [ "EPUB" => 177 "HTML" => 2568 "PDF" => 502 ] ] "pt" => array:13 [ "idiomaDefecto" => true "cabecera" => "Artigo Original" "titulo" => "Tumores cardíacos primários malignos: resultados cirúrgicos" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => array:2 [ 0 => "pt" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "199" "paginaFinal" => "204" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Primary Malignant Cardiac Tumors: Surgical results" ] ] "contieneResumen" => array:2 [ "pt" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1225 "Ancho" => 1644 "Tamanyo" => 52257 ] ] "descripcion" => array:1 [ "pt" => "Sobrevida dos doentes com sarcomas cardíacos primários." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Joana Saraiva, Pedro Engrácia Antunes, Lina Carvalho, Manuel Jesus Antunes" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Joana" "apellidos" => "Saraiva" ] 1 => array:2 [ "nombre" => "Pedro Engrácia" "apellidos" => "Antunes" ] 2 => array:2 [ "nombre" => "Lina" "apellidos" => "Carvalho" ] 3 => array:2 [ "nombre" => "Manuel Jesus" "apellidos" => "Antunes" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204916000611" "doi" => "10.1016/j.repce.2016.03.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916000611?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116000123?idApp=UINPBA00004E" "url" => "/08702551/0000003500000004/v1_201604010041/S0870255116000123/v1_201604010041/pt/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2174204916000623" "issn" => "21742049" "doi" => "10.1016/j.repce.2016.03.004" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "780" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2016;35:205-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2118 "formatos" => array:3 [ "EPUB" => 153 "HTML" => 1570 "PDF" => 395 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Editorial comment" "titulo" => "Primary malignant cardiac tumors: Surgical results" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "205" "paginaFinal" => "206" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Tumores cardíacos primários malignos: resultados cirúrgicos" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Fragata" "autores" => array:1 [ 0 => array:2 [ "nombre" => "José" "apellidos" => "Fragata" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S087025511600038X" "doi" => "10.1016/j.repc.2016.02.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511600038X?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916000623?idApp=UINPBA00004E" "url" => "/21742049/0000003500000004/v2_201703300127/S2174204916000623/v2_201703300127/en/main.assets" ] "asociados" => array:1 [ 0 => array:20 [ "pii" => "S2174204916000623" "issn" => "21742049" "doi" => "10.1016/j.repce.2016.03.004" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "780" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2016;35:205-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2118 "formatos" => array:3 [ "EPUB" => 153 "HTML" => 1570 "PDF" => 395 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Editorial comment" "titulo" => "Primary malignant cardiac tumors: Surgical results" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "205" "paginaFinal" => "206" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Tumores cardíacos primários malignos: resultados cirúrgicos" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Fragata" "autores" => array:1 [ 0 => array:2 [ "nombre" => "José" "apellidos" => "Fragata" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S087025511600038X" "doi" => "10.1016/j.repc.2016.02.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511600038X?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916000623?idApp=UINPBA00004E" "url" => "/21742049/0000003500000004/v2_201703300127/S2174204916000623/v2_201703300127/en/main.assets" ] ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Primary malignant cardiac tumors: Surgical results" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "199" "paginaFinal" => "204" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Joana Saraiva, Pedro Engrácia Antunes, Lina Carvalho, Manuel Jesus Antunes" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Joana" "apellidos" => "Saraiva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Pedro Engrácia" "apellidos" => "Antunes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Lina" "apellidos" => "Carvalho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:4 [ "nombre" => "Manuel Jesus" "apellidos" => "Antunes" "email" => array:1 [ 0 => "antunes.cct.chuc@sapo.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Centro de Cirurgia Cardiotorácica, Centro Hospitalar Universitário e Faculdade de Medicina, Coimbra, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Anatomia Patologia, Centro Hospitalar Universitário e Faculdade de Medicina, Coimbra, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1222 "Ancho" => 1646 "Tamanyo" => 47194 ] ] "descripcion" => array:1 [ "en" => "Survival of patients with primary cardiac sarcomas." ] ] ] "textoCompleto" => "IntroductionPrimary cardiac tumors are rare, the incidence on autopsy varying between 0.0017% and 0.03%. Around 25% are malignant and most (75%) are sarcomas.<a class="elsevierStyleCrossRef" href="#bib0060">1</a>Cardiac tumors are generally asymptomatic until they are large enough to cause valve or chamber obstruction. Although they are easily detected by echocardiography, malignancy and specific histological type cannot always be determined or even suspected before surgical intervention.<a class="elsevierStyleCrossRef" href="#bib0065">2</a>The main treatment for primary malignant cardiac tumors, particularly sarcomas, is still complete surgical resection, combined with chemotherapy.<a class="elsevierStyleCrossRefs" href="#bib0070">3,4</a> Nevertheless, cardiac sarcomas have a poor prognosis, with mean survival of 11–17 months.<a class="elsevierStyleCrossRefs" href="#bib0060">1,5,6</a>The aim of this study was to characterize primary malignant cardiac tumors operated on in our center and to analyze patient survival.MethodsThis was a retrospective study of patients operated between January 1994 and August 2014. Information was collected from patients’ medical records, together with data on follow-up from hospital records and telephone contact with patients or relatives. During the study period, 23010 patients underwent cardiac surgery. Of these, 123 (0.53%) had cardiac tumors, but only 12 had primary malignant tumors, corresponding to 9.8% of all cardiac tumors and an incidence of 0.05% among patients undergoing cardiac surgery.Patients’ mean age was 55.4±16.9 years (21–79), 67% were female and 75% presented in NYHA class III–IV. The tumor was located in the left atrium in five cases (42%), the right atrium in four (33%), the right ventricle in two (17%) and the pulmonary valve in one (8%) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Eight of the tumors (67%) were sarcomas, three (25%) B-cell lymphomas and one (8.3%) epithelioid hemangioendothelioma. In the sarcoma group, there were three cases of angiosarcoma (38%) and one each of rhabdomyosarcoma, leiomyosarcoma, myxofibrosarcoma, undifferentiated sarcoma and myxochondrosarcoma.Only two patients had a histological diagnosis prior to surgery: one with an epithelioid hemangioendothelioma, previously biopsied by right thoracotomy, who had no known metastases and had not undergone neoadjuvant therapy; and the other with an angiosarcoma, diagnosed by mediastinoscopy, with lymph node metastasization and pericardial effusion, who had undergone neoadjuvant chemotherapy, resulting in reduction of the mass and resolution of the pericardial effusion. All the other tumors were diagnosed through anatomopathological analysis of the surgical specimens.The myxochondrosarcoma, myxofibrosarcoma and one of the lymphomas presented with pericardial effusion. One patient with angiosarcoma had liver metastases preoperatively and the patient with leiomyosarcoma presented diffuse lung metastases. One of the lymphomas presented as vena cava syndrome. The other cases had no known secondary locations. Surgical intervention was prompted by cardiac valve or chamber obstruction in all cases except that of the epithelioid hemangioendothelioma, which was causing no functional impairment.All patients were operated under cardiopulmonary bypass, in cardiac arrest following administration of cardioplegia and cooling to 28°C. The venae cavae were ligated in all cases that required the right atrium to be opened.Statistical analysisContinuous variables were expressed as means ± standard deviation and compared using the Student's t test. Survival (time from surgery to death or last recorded follow-up) was analyzed using the Kaplan-Meier method. A value of p<0.05 was considered statistically significant. The data were analyzed using IBM SPSS Statistics®, version 22.ResultsResection was complete (entire macroscopic tumor excised) in seven cases, although subsequent anatomopathological analysis showed positive margins in two of these (one angiosarcoma and the leiomyosarcoma). In the other five patients (three sarcomas and two lymphomas), it was macroscopically partial because complete resection was technically impossible and/or the main aim was to relieve cardiac valve or chamber obstruction and to obtain material for histological diagnosis.One patient required a pulmonary homograft, one mitral valvuloplasty (partial posterior annuloplasty), three atrial reconstruction with a bovine pericardial patch (one the left atrial roof, one the left atrial posterior wall and one the right atrial free wall) and one tricuspid valvuloplasty (reimplantation of the anterior leaflet and annuloplasty). There was no need for associated procedures in the other six patients. The procedures performed are shown by patient in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.All patients survived the operation and none required inotropic support. During hospital stay, the patient with epithelioid hemangioendothelioma had to be reoperated on the fifth postoperative day to repair a small perforation in the mitral valve posterior leaflet. Two other patients had episodes of atrial fibrillation, resolved with medical therapy. There were no major complications such as myocardial infarction, stroke or acute renal failure.All patients were discharged. Mean follow-up was 41.7±61.3 months overall, 24.8±30.0 months (3.8–95.7) for sarcomas and 70.1±118.0 months (1–206.3) for lymphomas. Ten patients (83%) died during follow-up and two (17%) were alive at the end of follow-up: one with epithelioid hemangioendothelioma, who had no signs of recurrence after 92 months; and another with B-cell lymphoma, who had been in remission for 206 months.Eleven patients underwent adjuvant therapy (neoadjuvant chemotherapy in one, adjuvant chemotherapy in all eleven, and radiotherapy in one who presented late bone metastases). The surgery was curative in two patients: as the only treatment in the case of epithelioid hemangioendothelioma (complete resection, with negative surgical margins); and associated with adjuvant chemotherapy in one of the patients with B-cell lymphoma (complete resection, with unspecified surgical margins).The other two patients with lymphoma, in whom the surgical aim was to biopsy the mass and relieve cardiac chamber obstruction, died following aggressive recurrence (one within 30 days of surgery and the other after three months), despite the fact that both had begun chemotherapy.All eight patients with sarcoma underwent adjuvant chemotherapy, of whom six had local recurrence, irrespective of negative margins or secondary location on pre-operative assessment, and who subsequently died. The patient with rhabdomyosarcoma suffered bone and brain metastasization but no local recurrence, and died of metastatic disease 18 months later. Another, with angiosarcoma but no signs of recurrence, died of pneumonia after seven months.Overall survival at 30 days, six months, one year and two years was 91.7%, 66.7%, 58.3% and 41.7%, respectively (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). In the sarcoma group, survival was 62.5% at one year and 37.5% at two years (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>), and there was a significant difference (p=0.01) in mean survival between those with partial resection and/or positive margins (14.4±12.0 months) and those with negative surgical margins (42.2±46.4 months). Finally, patients with angiosarcoma tended to present worse mean survival that those with other types of sarcoma (15.8±10.5 vs. 30.2±37.8 months), but the difference was not statistically significant (p=0.25).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>DiscussionA review of the literature shows that there are few institutional series of a significant number of patients with primary malignant cardiac tumors,<a class="elsevierStyleCrossRefs" href="#bib0060">1,5,7,8</a> most of which are exclusively sarcomas.<a class="elsevierStyleCrossRefs" href="#bib0060">1,5</a> There are two multicenter studies on sarcomas – one American, of 27 cases of cardiac sarcoma<a class="elsevierStyleCrossRef" href="#bib0100">9</a> and one by the French Sarcoma Group, with 124 patients.<a class="elsevierStyleCrossRef" href="#bib0085">6</a> Other publications are mainly case reports<a class="elsevierStyleCrossRef" href="#bib0105">10</a> or very small series.<a class="elsevierStyleCrossRef" href="#bib0070">3</a>Only 9.8% of the cardiac tumors treated in our center were malignant, lower than the 25% incidence reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0070">3,6</a> This may be explained by the fact that a significant number of patients had tumors that were too advanced for surgery. With regard to sarcomas, the incidence in our study was 67%, which is close to the 75% generally observed.The most common sarcoma was angiosarcoma, with most located in the right atrium, as reported in the literature. All three of our patients were women, but given the small number of cases, no gender predominance can be assumed, and other studies have observed no gender difference.<a class="elsevierStyleCrossRefs" href="#bib0060">1,5,6</a> Patients with angiosarcoma had a mean survival of 15.9±10.5 months, similar to the 14 months reported by Randhawa et al.,<a class="elsevierStyleCrossRef" href="#bib0080">5</a> but only slightly better than the average of death within 9–12 months without surgical resection.<a class="elsevierStyleCrossRef" href="#bib0110">11</a>Comparison of survival in the sarcoma group according to surgical margins showed that those with histologically negative margins had better outcomes, the difference being statistically significant, which is in agreement with other studies.<a class="elsevierStyleCrossRefs" href="#bib0060">1,6</a> This highlights the importance of extemporaneous histological examination and intraoperative assessment of surgical margins in future cases, as well as use of more aggressive surgical techniques such as autotransplantation. If a tumor is not resectable by conservative surgery, orthotopic transplantation may be considered,<a class="elsevierStyleCrossRefs" href="#bib0085">6,9</a> although this option is controversial. However, even partial resection is beneficial in the case of sarcomas, as it can provide immediate improvement in the patient's condition and help to control tumor growth.<a class="elsevierStyleCrossRef" href="#bib0085">6</a>According to the literature, primary cardiac lymphomas are rare and most respond well to radiotherapy and chemotherapy, and thus surgical resection is only rarely indicated. However, surgery can provide material for analysis when other diagnostic techniques have been inconclusive, and in specific cases can provide relief of obstructive symptoms. Two of our cases occurred more than 15 years ago, and previous histological diagnosis was not obtained in any of the three patients with lymphoma. In the patient who survived, resection was considered complete (histological analysis did not specify whether the margins were negative or positive) and adjuvant therapy was successful in controlling the disease; the patient had been in remission for 206 months. In the other two cases, resection was partial and adjuvant chemotherapy failed to control the disease, both patients surviving less than three months.The other patient in whom surgery was curative had an epithelioid hemangioendothelioma and had no signs of recurrence after 92 months. This is a rare malignant vascular tumor, with potential for systemic metastasis, and resection is accordingly indicated to prevent its spread.<a class="elsevierStyleCrossRef" href="#bib0105">10</a>Finally, although adjuvant therapy appears to have been successful in one lymphoma patient, it was not curative in any of the sarcoma patients, though it may have increased survival and improved quality of life. However, the small size of our series makes it almost impossible to assess the efficacy of these therapeutic approaches.ConclusionIn this study, patients with primary malignant cardiac tumors had a low survival rate. The surgery was rarely curative, but there was no mortality due to intraoperative complications and the incidence of surgical morbidity was low. In the sarcoma group, complete resection significantly increased survival, but even partial resection provided relief of obstructive symptoms and improved quality of life.Due to the rarity of such tumors, a multicenter database could improve knowledge and help clarify indications for cardiac surgery as a treatment option.Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.Confidentiality of dataThe authors declare that they have followed the protocols of their work center on the publication of patient data.Right to privacy and informed consentThe authors declare that no patient data appear in this article.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres821789" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec818738" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres821788" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec818737" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusion" ] 9 => array:3 [ "identificador" => "sec0035" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-07-21" "fechaAceptado" => "2015-11-21" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec818738" "palabras" => array:3 [ 0 => "Primary malignant cardiac tumors" 1 => "Sarcoma" 2 => "Surgery" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec818737" "palabras" => array:3 [ 0 => "Tumor cardíaco maligno primário" 1 => "Sarcoma" 2 => "Cirurgia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo characterize primary malignant cardiac tumors operated on in our center and to analyze patient survival. MethodsBetween January 1994 and August 2014, 123 patients with cardiac tumors underwent surgery, of which 12 (9.8%) were primary malignant tumors – eight sarcomas (67%), three B-cell lymphomas (25%) and one epithelioid hemangioendothelioma (8.3%). The tumor affected the left atrium in five cases (42%), the right atrium in four (33%), the right ventricle in two (17%) and the pulmonary valve in one (8%). Patients’ mean age was 55.4±16.9 years, 67% were female and 75% presented in NYHA class III–IV. ResultsResection was complete (negative margins) in five cases and partial in seven (five sarcomas and two lymphomas), and 11 patients needed adjuvant therapy, surgery alone being curative in only one (epithelioid hemangioendothelioma). Mean follow-up was 41.7±61.3 months: 24.8±30.0 months (3.8–95.7) for sarcomas, 70.1±118.0 months (1–206.3) for lymphomas and 91.9 months for the epithelioid hemangioendothelioma. During follow-up, 10 patients died (83%) and two were alive (17%). Overall survival at 30 days, six months, one year and two years was 91.7%, 66.7%, 58.3% and 41.7%, respectively. In the sarcoma group, 1-year and 2-year survival were 62.5% and 37.5%, respectively. ConclusionsResection of primary malignant cardiac tumors, even partial, is safe, provides relief of obstructive symptoms and improves quality of life, but is rarely curative and has a low survival rate. Due to the rarity of such tumors, a multicenter database could improve knowledge and help clarify the indications for cardiac surgery as a treatment option." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "ObjetivoCaracterizar os tumores malignos cardíacos operados no nosso centro e analisar a sobrevida dos doentes. MétodosDe janeiro/1994 a agosto/2014, 123 doentes com tumores cardíacos foram submetidos a cirurgia, dos quais 12 revelaram ser malignos (9,8%) – oito sarcomas (67%), três linfomas de células B (25%) e um hemangioendotelioma epitelioide (8,3%). A AE estava afetada em cinco casos (42%), a AD em quatro (33%), o VD em dois (17%) e a válvula pulmonar em um (8%). A idade média era 55,4±16,9 anos, 67% do sexo feminino e 75% apresentavam-se em classe III-IV da NYHA. ResultadosA ressecção foi completa (margens negativas) em cinco casos e parcial em sete (cinco sarcomas, dois linfomas). Onze doentes necessitaram de terapia adjuvante, sendo a cirurgia curativa em apenas um (hemangioendotelioma epitelioide). O tempo de seguimento médio foi de 41,7±61,3 meses; 24,8±30,0 (3,8-95,7 meses) para sarcomas, 70,1±118,0 (1-206,3 meses) para linfomas e 91,9 meses para o hemangioendotelioma epitelioide. Durante o seguimento, dez doentes faleceram (83%). A sobrevida global aos 30 dias, seis meses, um e dois anos foi de 91,7, 66,7, 58,3 e 41,7%, respetivamente. No grupo dos sarcomas, a sobrevida a um e dois anos foi de 62,5 e 37,5%. ConclusõesA ressecção de tumores malignos primários, mesmo que parcial, é segura, providencia alívio sintomático, podendo melhorar a qualidade de vida, mas é raramente curativa e tem baixa sobrevida. Dada a raridade, uma base de dados multicêntrica poderia melhorar o conhecimento e ajudar a clarificar as indicações cirúrgicas." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Saraiva J, Antunes PE, Carvalho L, Antunes MJ. Tumores cardíacos primários malignos: resultados cirúrgicos. Rev Port Cardiol. 2016;35:199–204." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1174 "Ancho" => 1590 "Tamanyo" => 58923 ] ] "descripcion" => array:1 [ "en" => "Survival of patients with primary malignant cardiac tumors." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1222 "Ancho" => 1646 "Tamanyo" => 47194 ] ] "descripcion" => array:1 [ "en" => "Survival of patients with primary cardiac sarcomas." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">M/F \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of tumor \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Location \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Resection/surgical margins<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Associated procedures \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Secondary location on preoperative assessment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Morbidity \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Adjuvant therapy \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Recurrence \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Current state \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Follow-up (months) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B-cell lymphoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Partial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pericardial effusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Post-op CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Heart \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Deceased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B-cell lymphoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Complete/unspecified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tricuspid valvuloplasty \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Post-op CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Alive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">206 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B-cell lymphoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Partial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vena cava syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Post-op CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Heart \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Deceased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Myxofibrosarcoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Complete/negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pericardial effusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Post-op CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Heart \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Deceased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Rhabdomyosarcoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Complete/negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LA bovine patch \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Post-op CT + RT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bone and brain metastases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Deceased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Undifferentiated sarcoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Partial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Post-op CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Heart \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Deceased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Angiosarcoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Complete/negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pericardial effusion + ganglion metastases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Neoadjuvant CT + post-op CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Heart and lymph nodes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Deceased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Leiomyosarcoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Complete/positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RA bovine patch \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lung metastases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Post-op CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lung \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Deceased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Angiosarcoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Partial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Liver metastases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Post-op CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Heart \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Deceased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Myxochondrosarcoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Partial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mitral valvulo plasty \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pericardial effusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Post-op CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Heart \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Deceased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Angiosarcoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pulmonary valve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Complete/positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pulmonary homograft \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Post-op CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Deceased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Epithelioid hemangioendothelioma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Complete/negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LA bovine patch \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Alive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1381737.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Resection: macroscopic surgical resection; Surgical margins: negative means no tumor cells on histological analysis of the margins of the surgical specimen, while positive indicates the presence of tumor cells. AF: atrial fibrillation; F: female; LA: left atrium; M: male; Post-op CT: post-operative chemotherapy; RA: right atrium; RT: radiotherapy; RV: right ventricle." ] ] ] "descripcion" => array:1 [ "en" => "Description of the population with primary malignant cardiac tumors." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malignant primary cardiac tumors. Review of a single institution experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L. Simpson" 1 => "S. Kumar" 2 => "S. Okuno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/cncr.23459" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "2008" "volumen" => "112" "paginaInicial" => "2440" "paginaFinal" => "2446" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18428209" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0065" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malignant primary cardiac tumors. The Cleveland Clinic experience, 1956 to 1986" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.A. Bear" 1 => "D.S. Moodie" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Chest" "fecha" => "1987" "volumen" => "92" "paginaInicial" => "860" "paginaFinal" => "862" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3665601" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109714064791" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0070" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malignant primary cardiac tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Burnside" 1 => "S.W. Macgowan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/icvts/ivs350" "Revista" => array:6 [ "tituloSerie" => "Interact Cardiovasc Thorac Surg" "fecha" => "2012" "volumen" => "15" "paginaInicial" => "1004" "paginaFinal" => "1006" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22922450" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0075" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac sarcomas: an update" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Orlandi" 1 => "A. Ferlosio" 2 => "M. Roselli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Thoracic Oncol" "fecha" => "2010" "volumen" => "5" "paginaInicial" => "1483" "paginaFinal" => "1489" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0080" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Epub ahead of print]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary cardiac sarcoma: 25-year Cleveland Clinic experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Randhawa" 1 => "G. Budd" 2 => "M. Randhawa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Am J Clin Oncol" "fecha" => "2014" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9256889" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109712049285" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0085" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary cardiac sarcomas: a retrospective study of the French Sarcoma Group" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. Isambert" 1 => "I. Ray-Coquard" 2 => "A. Italiano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejca.2013.09.012" "Revista" => array:6 [ "tituloSerie" => "Eur J Cancer" "fecha" => "2014" "volumen" => "50" "paginaInicial" => "128" "paginaFinal" => "136" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24135684" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0090" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary malignant cardiac tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L. Yu" 1 => "T. Gu" 2 => "E. Shi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00432-014-1651-1" "Revista" => array:6 [ "tituloSerie" => "J Cancer Res Clin Oncol" "fecha" => "2014" "volumen" => "140" "paginaInicial" => "1047" "paginaFinal" => "1055" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24671225" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0095" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathological study of primary cardiac and pericardial tumors in a specialist UK centre: surgical and autopsy series" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Patel" 1 => "M. Sheppard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.carpath.2009.07.005" "Revista" => array:6 [ "tituloSerie" => "Cardiovasc Pathol" "fecha" => "2010" "volumen" => "19" "paginaInicial" => "343" "paginaFinal" => "352" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19747857" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0100" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary cardiac sarcomas: a clinicopathologic analysis of a series with follow-up information in 17 patients and emphasis on long-term survival" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Zhang" 1 => "J. Brooks" 2 => "J. Goldblum" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.humpath.2008.01.019" "Revista" => array:6 [ "tituloSerie" => "Hum Pathol" "fecha" => "2008" "volumen" => "39" "paginaInicial" => "1385" "paginaFinal" => "1395" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18602663" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0105" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary left atrial hemangioendothelioma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Messias" 1 => "J. Bernardo" 2 => "M.J. Antunes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1510/icvts.2008.184085" "Revista" => array:6 [ "tituloSerie" => "Interact Cardiovasc Thorac Surg" "fecha" => "2008" "volumen" => "7" "paginaInicial" => "945" "paginaFinal" => "946" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18635584" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0110" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac neoplasms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Blackman" 1 => "M. Reardon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Cardiac surgery in the adult" "paginaInicial" => "1245" "paginaFinal" => "1275" "edicion" => "4th edition" "serieFecha" => "2012" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003500000004/v2_201703300127/S2174204916000611/v2_201703300127/en/main.assets" "Apartado" => array:4 [ "identificador" => "9917" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003500000004/v2_201703300127/S2174204916000611/v2_201703300127/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916000611?idApp=UINPBA00004E"]

Statistics

Original Article

Primary malignant cardiac tumors: Surgical results

Joana Saraivaa, Pedro Engrácia Antunesa, Lina Carvalhob, Manuel Jesus Antunesa,

Corresponding author

antunes.cct.chuc@sapo.pt

Corresponding author.

a Centro de Cirurgia Cardiotorácica, Centro Hospitalar Universitário e Faculdade de Medicina, Coimbra, Portugal

b Departamento de Anatomia Patologia, Centro Hospitalar Universitário e Faculdade de Medicina, Coimbra, Portugal

Read

4665

Times
was read the article

1650

Total PDF

3015

Total HTML

Share statistics

 array:25 [
  "pii" => "S2174204916000611"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2016.03.003"
  "estado" => "S300"
  "fechaPublicacion" => "2016-04-01"
  "aid" => "769"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Cardiol. 2016;35:199-204"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2226
    "formatos" => array:3 [
      "EPUB" => 145
      "HTML" => 1610
      "PDF" => 471
    ]
  ]
  "Traduccion" => array:1 [
    "pt" => array:20 [
      "pii" => "S0870255116000123"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2015.11.005"
      "estado" => "S300"
      "fechaPublicacion" => "2016-04-01"
      "aid" => "769"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Rev Port Cardiol. 2016;35:199-204"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 3247
        "formatos" => array:3 [
          "EPUB" => 177
          "HTML" => 2568
          "PDF" => 502
        ]
      ]
      "pt" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Artigo Original</span>"
        "titulo" => "Tumores card&#237;acos prim&#225;rios malignos&#58; resultados cir&#250;rgicos"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "tieneResumen" => array:2 [
          0 => "pt"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "199"
            "paginaFinal" => "204"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Primary Malignant Cardiac Tumors&#58; Surgical results"
          ]
        ]
        "contieneResumen" => array:2 [
          "pt" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 1225
                "Ancho" => 1644
                "Tamanyo" => 52257
              ]
            ]
            "descripcion" => array:1 [
              "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Sobrevida dos doentes com sarcomas card&#237;acos prim&#225;rios&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Joana Saraiva, Pedro Engr&#225;cia Antunes, Lina Carvalho, Manuel Jesus Antunes"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Joana"
                "apellidos" => "Saraiva"
              ]
              1 => array:2 [
                "nombre" => "Pedro Engr&#225;cia"
                "apellidos" => "Antunes"
              ]
              2 => array:2 [
                "nombre" => "Lina"
                "apellidos" => "Carvalho"
              ]
              3 => array:2 [
                "nombre" => "Manuel Jesus"
                "apellidos" => "Antunes"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2174204916000611"
          "doi" => "10.1016/j.repce.2016.03.003"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916000611?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116000123?idApp=UINPBA00004E"
      "url" => "/08702551/0000003500000004/v1_201604010041/S0870255116000123/v1_201604010041/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2174204916000623"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2016.03.004"
    "estado" => "S300"
    "fechaPublicacion" => "2016-04-01"
    "aid" => "780"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "dis"
    "cita" => "Rev Port Cardiol. 2016;35:205-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2118
      "formatos" => array:3 [
        "EPUB" => 153
        "HTML" => 1570
        "PDF" => 395
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>"
      "titulo" => "Primary malignant cardiac tumors&#58; Surgical results"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "205"
          "paginaFinal" => "206"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Tumores card&#237;acos prim&#225;rios malignos&#58; resultados cir&#250;rgicos"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jos&#233; Fragata"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "Jos&#233;"
              "apellidos" => "Fragata"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S087025511600038X"
        "doi" => "10.1016/j.repc.2016.02.001"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511600038X?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916000623?idApp=UINPBA00004E"
    "url" => "/21742049/0000003500000004/v2_201703300127/S2174204916000623/v2_201703300127/en/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:20 [
      "pii" => "S2174204916000623"
      "issn" => "21742049"
      "doi" => "10.1016/j.repce.2016.03.004"
      "estado" => "S300"
      "fechaPublicacion" => "2016-04-01"
      "aid" => "780"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "dis"
      "cita" => "Rev Port Cardiol. 2016;35:205-6"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 2118
        "formatos" => array:3 [
          "EPUB" => 153
          "HTML" => 1570
          "PDF" => 395
        ]
      ]
      "en" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>"
        "titulo" => "Primary malignant cardiac tumors&#58; Surgical results"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "205"
            "paginaFinal" => "206"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Tumores card&#237;acos prim&#225;rios malignos&#58; resultados cir&#250;rgicos"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Jos&#233; Fragata"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "Jos&#233;"
                "apellidos" => "Fragata"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "pt" => array:9 [
          "pii" => "S087025511600038X"
          "doi" => "10.1016/j.repc.2016.02.001"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "pt"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511600038X?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916000623?idApp=UINPBA00004E"
      "url" => "/21742049/0000003500000004/v2_201703300127/S2174204916000623/v2_201703300127/en/main.assets"
    ]
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Primary malignant cardiac tumors&#58; Surgical results"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "199"
        "paginaFinal" => "204"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Joana Saraiva, Pedro Engr&#225;cia Antunes, Lina Carvalho, Manuel Jesus Antunes"
        "autores" => array:4 [
          0 => array:3 [
            "nombre" => "Joana"
            "apellidos" => "Saraiva"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Pedro Engr&#225;cia"
            "apellidos" => "Antunes"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Lina"
            "apellidos" => "Carvalho"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:4 [
            "nombre" => "Manuel Jesus"
            "apellidos" => "Antunes"
            "email" => array:1 [
              0 => "antunes&#46;cct&#46;chuc&#64;sapo&#46;pt"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Centro de Cirurgia Cardiotor&#225;cica&#44; Centro Hospitalar Universit&#225;rio e Faculdade de Medicina&#44; Coimbra&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Departamento de Anatomia Patologia&#44; Centro Hospitalar Universit&#225;rio e Faculdade de Medicina&#44; Coimbra&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1222
            "Ancho" => 1646
            "Tamanyo" => 47194
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Survival of patients with primary cardiac sarcomas&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Primary cardiac tumors are rare&#44; the incidence on autopsy varying between 0&#46;0017&#37; and 0&#46;03&#37;&#46; Around 25&#37; are malignant and most &#40;75&#37;&#41; are sarcomas&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Cardiac tumors are generally asymptomatic until they are large enough to cause valve or chamber obstruction&#46; Although they are easily detected by echocardiography&#44; malignancy and specific histological type cannot always be determined or even suspected before surgical intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The main treatment for primary malignant cardiac tumors&#44; particularly sarcomas&#44; is still complete surgical resection&#44; combined with chemotherapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3&#44;4</span></a> Nevertheless&#44; cardiac sarcomas have a poor prognosis&#44; with mean survival of 11&#8211;17 months&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1&#44;5&#44;6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study was to characterize primary malignant cardiac tumors operated on in our center and to analyze patient survival&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a retrospective study of patients operated between January 1994 and August 2014&#46; Information was collected from patients&#8217; medical records&#44; together with data on follow-up from hospital records and telephone contact with patients or relatives&#46; During the study period&#44; 23<span class="elsevierStyleHsp" style=""></span>010 patients underwent cardiac surgery&#46; Of these&#44; 123 &#40;0&#46;53&#37;&#41; had cardiac tumors&#44; but only 12 had primary malignant tumors&#44; corresponding to 9&#46;8&#37; of all cardiac tumors and an incidence of 0&#46;05&#37; among patients undergoing cardiac surgery&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients&#8217; mean age was 55&#46;4&#177;16&#46;9 years &#40;21&#8211;79&#41;&#44; 67&#37; were female and 75&#37; presented in NYHA class III&#8211;IV&#46; The tumor was located in the left atrium in five cases &#40;42&#37;&#41;&#44; the right atrium in four &#40;33&#37;&#41;&#44; the right ventricle in two &#40;17&#37;&#41; and the pulmonary valve in one &#40;8&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Eight of the tumors &#40;67&#37;&#41; were sarcomas&#44; three &#40;25&#37;&#41; B-cell lymphomas and one &#40;8&#46;3&#37;&#41; epithelioid hemangioendothelioma&#46; In the sarcoma group&#44; there were three cases of angiosarcoma &#40;38&#37;&#41; and one each of rhabdomyosarcoma&#44; leiomyosarcoma&#44; myxofibrosarcoma&#44; undifferentiated sarcoma and myxochondrosarcoma&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Only two patients had a histological diagnosis prior to surgery&#58; one with an epithelioid hemangioendothelioma&#44; previously biopsied by right thoracotomy&#44; who had no known metastases and had not undergone neoadjuvant therapy&#59; and the other with an angiosarcoma&#44; diagnosed by mediastinoscopy&#44; with lymph node metastasization and pericardial effusion&#44; who had undergone neoadjuvant chemotherapy&#44; resulting in reduction of the mass and resolution of the pericardial effusion&#46; All the other tumors were diagnosed through anatomopathological analysis of the surgical specimens&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The myxochondrosarcoma&#44; myxofibrosarcoma and one of the lymphomas presented with pericardial effusion&#46; One patient with angiosarcoma had liver metastases preoperatively and the patient with leiomyosarcoma presented diffuse lung metastases&#46; One of the lymphomas presented as vena cava syndrome&#46; The other cases had no known secondary locations&#46; Surgical intervention was prompted by cardiac valve or chamber obstruction in all cases except that of the epithelioid hemangioendothelioma&#44; which was causing no functional impairment&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">All patients were operated under cardiopulmonary bypass&#44; in cardiac arrest following administration of cardioplegia and cooling to 28<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; The venae cavae were ligated in all cases that required the right atrium to be opened&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Continuous variables were expressed as means &#177; standard deviation and compared using the Student&#39;s t test&#46; Survival &#40;time from surgery to death or last recorded follow-up&#41; was analyzed using the Kaplan-Meier method&#46; A value of p&#60;0&#46;05 was considered statistically significant&#46; The data were analyzed using IBM SPSS Statistics<span class="elsevierStyleSup">&#174;</span>&#44; version 22&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">Resection was complete &#40;entire macroscopic tumor excised&#41; in seven cases&#44; although subsequent anatomopathological analysis showed positive margins in two of these &#40;one angiosarcoma and the leiomyosarcoma&#41;&#46; In the other five patients &#40;three sarcomas and two lymphomas&#41;&#44; it was macroscopically partial because complete resection was technically impossible and&#47;or the main aim was to relieve cardiac valve or chamber obstruction and to obtain material for histological diagnosis&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">One patient required a pulmonary homograft&#44; one mitral valvuloplasty &#40;partial posterior annuloplasty&#41;&#44; three atrial reconstruction with a bovine pericardial patch &#40;one the left atrial roof&#44; one the left atrial posterior wall and one the right atrial free wall&#41; and one tricuspid valvuloplasty &#40;reimplantation of the anterior leaflet and annuloplasty&#41;&#46; There was no need for associated procedures in the other six patients&#46; The procedures performed are shown by patient in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">All patients survived the operation and none required inotropic support&#46; During hospital stay&#44; the patient with epithelioid hemangioendothelioma had to be reoperated on the fifth postoperative day to repair a small perforation in the mitral valve posterior leaflet&#46; Two other patients had episodes of atrial fibrillation&#44; resolved with medical therapy&#46; There were no major complications such as myocardial infarction&#44; stroke or acute renal failure&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">All patients were discharged&#46; Mean follow-up was 41&#46;7&#177;61&#46;3 months overall&#44; 24&#46;8&#177;30&#46;0 months &#40;3&#46;8&#8211;95&#46;7&#41; for sarcomas and 70&#46;1&#177;118&#46;0 months &#40;1&#8211;206&#46;3&#41; for lymphomas&#46; Ten patients &#40;83&#37;&#41; died during follow-up and two &#40;17&#37;&#41; were alive at the end of follow-up&#58; one with epithelioid hemangioendothelioma&#44; who had no signs of recurrence after 92 months&#59; and another with B-cell lymphoma&#44; who had been in remission for 206 months&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Eleven patients underwent adjuvant therapy &#40;neoadjuvant chemotherapy in one&#44; adjuvant chemotherapy in all eleven&#44; and radiotherapy in one who presented late bone metastases&#41;&#46; The surgery was curative in two patients&#58; as the only treatment in the case of epithelioid hemangioendothelioma &#40;complete resection&#44; with negative surgical margins&#41;&#59; and associated with adjuvant chemotherapy in one of the patients with B-cell lymphoma &#40;complete resection&#44; with unspecified surgical margins&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The other two patients with lymphoma&#44; in whom the surgical aim was to biopsy the mass and relieve cardiac chamber obstruction&#44; died following aggressive recurrence &#40;one within 30 days of surgery and the other after three months&#41;&#44; despite the fact that both had begun chemotherapy&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">All eight patients with sarcoma underwent adjuvant chemotherapy&#44; of whom six had local recurrence&#44; irrespective of negative margins or secondary location on pre-operative assessment&#44; and who subsequently died&#46; The patient with rhabdomyosarcoma suffered bone and brain metastasization but no local recurrence&#44; and died of metastatic disease 18 months later&#46; Another&#44; with angiosarcoma but no signs of recurrence&#44; died of pneumonia after seven months&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Overall survival at 30 days&#44; six months&#44; one year and two years was 91&#46;7&#37;&#44; 66&#46;7&#37;&#44; 58&#46;3&#37; and 41&#46;7&#37;&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; In the sarcoma group&#44; survival was 62&#46;5&#37; at one year and 37&#46;5&#37; at two years &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#44; and there was a significant difference &#40;p&#61;0&#46;01&#41; in mean survival between those with partial resection and&#47;or positive margins &#40;14&#46;4&#177;12&#46;0 months&#41; and those with negative surgical margins &#40;42&#46;2&#177;46&#46;4 months&#41;&#46; Finally&#44; patients with angiosarcoma tended to present worse mean survival that those with other types of sarcoma &#40;15&#46;8&#177;10&#46;5 vs&#46; 30&#46;2&#177;37&#46;8 months&#41;&#44; but the difference was not statistically significant &#40;p&#61;0&#46;25&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">A review of the literature shows that there are few institutional series of a significant number of patients with primary malignant cardiac tumors&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1&#44;5&#44;7&#44;8</span></a> most of which are exclusively sarcomas&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1&#44;5</span></a> There are two multicenter studies on sarcomas &#8211; one American&#44; of 27 cases of cardiac sarcoma<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> and one by the French Sarcoma Group&#44; with 124 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> Other publications are mainly case reports<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> or very small series&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Only 9&#46;8&#37; of the cardiac tumors treated in our center were malignant&#44; lower than the 25&#37; incidence reported in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3&#44;6</span></a> This may be explained by the fact that a significant number of patients had tumors that were too advanced for surgery&#46; With regard to sarcomas&#44; the incidence in our study was 67&#37;&#44; which is close to the 75&#37; generally observed&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The most common sarcoma was angiosarcoma&#44; with most located in the right atrium&#44; as reported in the literature&#46; All three of our patients were women&#44; but given the small number of cases&#44; no gender predominance can be assumed&#44; and other studies have observed no gender difference&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1&#44;5&#44;6</span></a> Patients with angiosarcoma had a mean survival of 15&#46;9&#177;10&#46;5 months&#44; similar to the 14 months reported by Randhawa et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> but only slightly better than the average of death within 9&#8211;12 months without surgical resection&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Comparison of survival in the sarcoma group according to surgical margins showed that those with histologically negative margins had better outcomes&#44; the difference being statistically significant&#44; which is in agreement with other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1&#44;6</span></a> This highlights the importance of extemporaneous histological examination and intraoperative assessment of surgical margins in future cases&#44; as well as use of more aggressive surgical techniques such as autotransplantation&#46; If a tumor is not resectable by conservative surgery&#44; orthotopic transplantation may be considered&#44;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">6&#44;9</span></a> although this option is controversial&#46; However&#44; even partial resection is beneficial in the case of sarcomas&#44; as it can provide immediate improvement in the patient&#39;s condition and help to control tumor growth&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">According to the literature&#44; primary cardiac lymphomas are rare and most respond well to radiotherapy and chemotherapy&#44; and thus surgical resection is only rarely indicated&#46; However&#44; surgery can provide material for analysis when other diagnostic techniques have been inconclusive&#44; and in specific cases can provide relief of obstructive symptoms&#46; Two of our cases occurred more than 15 years ago&#44; and previous histological diagnosis was not obtained in any of the three patients with lymphoma&#46; In the patient who survived&#44; resection was considered complete &#40;histological analysis did not specify whether the margins were negative or positive&#41; and adjuvant therapy was successful in controlling the disease&#59; the patient had been in remission for 206 months&#46; In the other two cases&#44; resection was partial and adjuvant chemotherapy failed to control the disease&#44; both patients surviving less than three months&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The other patient in whom surgery was curative had an epithelioid hemangioendothelioma and had no signs of recurrence after 92 months&#46; This is a rare malignant vascular tumor&#44; with potential for systemic metastasis&#44; and resection is accordingly indicated to prevent its spread&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Finally&#44; although adjuvant therapy appears to have been successful in one lymphoma patient&#44; it was not curative in any of the sarcoma patients&#44; though it may have increased survival and improved quality of life&#46; However&#44; the small size of our series makes it almost impossible to assess the efficacy of these therapeutic approaches&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0135" class="elsevierStylePara elsevierViewall">In this study&#44; patients with primary malignant cardiac tumors had a low survival rate&#46; The surgery was rarely curative&#44; but there was no mortality due to intraoperative complications and the incidence of surgical morbidity was low&#46; In the sarcoma group&#44; complete resection significantly increased survival&#44; but even partial resection provided relief of obstructive symptoms and improved quality of life&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Due to the rarity of such tumors&#44; a multicenter database could improve knowledge and help clarify indications for cardiac surgery as a treatment option&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical disclosures</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Protection of human and animal subjects</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Confidentiality of data</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Right to privacy and informed consent</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres821789"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objective"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec818738"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres821788"
          "titulo" => "Resumo"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclus&#245;es"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec818737"
          "titulo" => "Palavras-chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conclusion"
        ]
        9 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        10 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflicts of interest"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-07-21"
    "fechaAceptado" => "2015-11-21"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec818738"
          "palabras" => array:3 [
            0 => "Primary malignant cardiac tumors"
            1 => "Sarcoma"
            2 => "Surgery"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec818737"
          "palabras" => array:3 [
            0 => "Tumor card&#237;aco maligno prim&#225;rio"
            1 => "Sarcoma"
            2 => "Cirurgia"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To characterize primary malignant cardiac tumors operated on in our center and to analyze patient survival&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Between January 1994 and August 2014&#44; 123 patients with cardiac tumors underwent surgery&#44; of which 12 &#40;9&#46;8&#37;&#41; were primary malignant tumors &#8211; eight sarcomas &#40;67&#37;&#41;&#44; three B-cell lymphomas &#40;25&#37;&#41; and one epithelioid hemangioendothelioma &#40;8&#46;3&#37;&#41;&#46; The tumor affected the left atrium in five cases &#40;42&#37;&#41;&#44; the right atrium in four &#40;33&#37;&#41;&#44; the right ventricle in two &#40;17&#37;&#41; and the pulmonary valve in one &#40;8&#37;&#41;&#46; Patients&#8217; mean age was 55&#46;4&#177;16&#46;9 years&#44; 67&#37; were female and 75&#37; presented in NYHA class III&#8211;IV&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Resection was complete &#40;negative margins&#41; in five cases and partial in seven &#40;five sarcomas and two lymphomas&#41;&#44; and 11 patients needed adjuvant therapy&#44; surgery alone being curative in only one &#40;epithelioid hemangioendothelioma&#41;&#46; Mean follow-up was 41&#46;7&#177;61&#46;3 months&#58; 24&#46;8&#177;30&#46;0 months &#40;3&#46;8&#8211;95&#46;7&#41; for sarcomas&#44; 70&#46;1&#177;118&#46;0 months &#40;1&#8211;206&#46;3&#41; for lymphomas and 91&#46;9 months for the epithelioid hemangioendothelioma&#46; During follow-up&#44; 10 patients died &#40;83&#37;&#41; and two were alive &#40;17&#37;&#41;&#46; Overall survival at 30 days&#44; six months&#44; one year and two years was 91&#46;7&#37;&#44; 66&#46;7&#37;&#44; 58&#46;3&#37; and 41&#46;7&#37;&#44; respectively&#46; In the sarcoma group&#44; 1-year and 2-year survival were 62&#46;5&#37; and 37&#46;5&#37;&#44; respectively&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Resection of primary malignant cardiac tumors&#44; even partial&#44; is safe&#44; provides relief of obstructive symptoms and improves quality of life&#44; but is rarely curative and has a low survival rate&#46; Due to the rarity of such tumors&#44; a multicenter database could improve knowledge and help clarify the indications for cardiac surgery as a treatment option&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Caracterizar os tumores malignos card&#237;acos operados no nosso centro e analisar a sobrevida dos doentes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">De janeiro&#47;1994 a agosto&#47;2014&#44; 123 doentes com tumores card&#237;acos foram submetidos a cirurgia&#44; dos quais 12 revelaram ser malignos &#40;9&#44;8&#37;&#41; &#8211; oito sarcomas &#40;67&#37;&#41;&#44; tr&#234;s linfomas de c&#233;lulas B &#40;25&#37;&#41; e um hemangioendotelioma epitelioide &#40;8&#44;3&#37;&#41;&#46; A AE estava afetada em cinco casos &#40;42&#37;&#41;&#44; a AD em quatro &#40;33&#37;&#41;&#44; o VD em dois &#40;17&#37;&#41; e a v&#225;lvula pulmonar em um &#40;8&#37;&#41;&#46; A idade m&#233;dia era 55&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;9 anos&#44; 67&#37; do sexo feminino e 75&#37; apresentavam-se em classe <span class="elsevierStyleSmallCaps">III</span>-<span class="elsevierStyleSmallCaps">IV</span> da NYHA&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A ressec&#231;&#227;o foi completa &#40;margens negativas&#41; em cinco casos e parcial em sete &#40;cinco sarcomas&#44; dois linfomas&#41;&#46; Onze doentes necessitaram de terapia adjuvante&#44; sendo a cirurgia curativa em apenas um &#40;hemangioendotelioma epitelioide&#41;&#46; O tempo de seguimento m&#233;dio foi de 41&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>61&#44;3 meses&#59; 24&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&#44;0 &#40;3&#44;8-95&#44;7 meses&#41; para sarcomas&#44; 70&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>118&#44;0 &#40;1-206&#44;3 meses&#41; para linfomas e 91&#44;9 meses para o hemangioendotelioma epitelioide&#46; Durante o seguimento&#44; dez doentes faleceram &#40;83&#37;&#41;&#46; A sobrevida global aos 30 dias&#44; seis meses&#44; um e dois anos foi de 91&#44;7&#44; 66&#44;7&#44; 58&#44;3 e 41&#44;7&#37;&#44; respetivamente&#46; No grupo dos sarcomas&#44; a sobrevida a um e dois anos foi de 62&#44;5 e 37&#44;5&#37;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A ressec&#231;&#227;o de tumores malignos prim&#225;rios&#44; mesmo que parcial&#44; &#233; segura&#44; providencia al&#237;vio sintom&#225;tico&#44; podendo melhorar a qualidade de vida&#44; mas &#233; raramente curativa e tem baixa sobrevida&#46; Dada a raridade&#44; uma base de dados multic&#234;ntrica poderia melhorar o conhecimento e ajudar a clarificar as indica&#231;&#245;es cir&#250;rgicas&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#245;es"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Saraiva J&#44; Antunes PE&#44; Carvalho L&#44; Antunes MJ&#46; Tumores card&#237;acos prim&#225;rios malignos&#58; resultados cir&#250;rgicos&#46; Rev Port Cardiol&#46; 2016&#59;35&#58;199&#8211;204&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1174
            "Ancho" => 1590
            "Tamanyo" => 58923
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Survival of patients with primary malignant cardiac tumors&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1222
            "Ancho" => 1646
            "Tamanyo" => 47194
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Survival of patients with primary cardiac sarcomas&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">M&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of tumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Location&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Resection&#47;surgical margins<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Associated procedures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Secondary location on preoperative assessment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Morbidity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Adjuvant therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Recurrence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Current state&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Follow-up &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B-cell lymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Partial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pericardial effusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Post-op CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Heart&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deceased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B-cell lymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complete&#47;unspecified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tricuspid valvuloplasty&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Post-op CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">206&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B-cell lymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Partial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vena cava syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Post-op CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Heart&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deceased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Myxofibrosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">LA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complete&#47;negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pericardial effusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Post-op CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Heart&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deceased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rhabdomyosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">LA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complete&#47;negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">LA bovine patch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Post-op CT &#43; RT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bone and brain metastases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deceased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Undifferentiated sarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">LA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Partial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Post-op CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Heart&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deceased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Angiosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complete&#47;negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pericardial effusion &#43; ganglion metastases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Neoadjuvant CT &#43; post-op CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Heart and lymph nodes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deceased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Leiomyosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complete&#47;positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RA bovine patch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lung metastases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Post-op CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lung&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deceased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Angiosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Partial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Liver metastases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Post-op CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Heart&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deceased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Myxochondrosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">LA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Partial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mitral valvulo plasty&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pericardial effusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Post-op CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Heart&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deceased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Angiosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pulmonary valve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complete&#47;positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pulmonary homograft&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Post-op CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deceased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Epithelioid hemangioendothelioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">LA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complete&#47;negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">LA bovine patch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1381737.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Resection&#58; macroscopic surgical resection&#59; Surgical margins&#58; negative means no tumor cells on histological analysis of the margins of the surgical specimen&#44; while positive indicates the presence of tumor cells&#46;</p> <p class="elsevierStyleNotepara" id="npar0010">AF&#58; atrial fibrillation&#59; F&#58; female&#59; LA&#58; left atrium&#59; M&#58; male&#59; Post-op CT&#58; post-operative chemotherapy&#59; RA&#58; right atrium&#59; RT&#58; radiotherapy&#59; RV&#58; right ventricle&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Description of the population with primary malignant cardiac tumors&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:11 [
            0 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant primary cardiac tumors&#46; Review of a single institution experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46; Simpson"
                            1 => "S&#46; Kumar"
                            2 => "S&#46; Okuno"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/cncr.23459"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "2008"
                        "volumen" => "112"
                        "paginaInicial" => "2440"
                        "paginaFinal" => "2446"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18428209"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant primary cardiac tumors&#46; The Cleveland Clinic experience&#44; 1956 to 1986"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;A&#46; Bear"
                            1 => "D&#46;S&#46; Moodie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1987"
                        "volumen" => "92"
                        "paginaInicial" => "860"
                        "paginaFinal" => "862"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3665601"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109714064791"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant primary cardiac tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46; Burnside"
                            1 => "S&#46;W&#46; Macgowan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/icvts/ivs350"
                      "Revista" => array:6 [
                        "tituloSerie" => "Interact Cardiovasc Thorac Surg"
                        "fecha" => "2012"
                        "volumen" => "15"
                        "paginaInicial" => "1004"
                        "paginaFinal" => "1006"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22922450"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac sarcomas&#58; an update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Orlandi"
                            1 => "A&#46; Ferlosio"
                            2 => "M&#46; Roselli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Thoracic Oncol"
                        "fecha" => "2010"
                        "volumen" => "5"
                        "paginaInicial" => "1483"
                        "paginaFinal" => "1489"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "&#91;Epub ahead of print&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primary cardiac sarcoma&#58; 25-year Cleveland Clinic experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Randhawa"
                            1 => "G&#46; Budd"
                            2 => "M&#46; Randhawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Am J Clin Oncol"
                        "fecha" => "2014"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9256889"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109712049285"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primary cardiac sarcomas&#58; a retrospective study of the French Sarcoma Group"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N&#46; Isambert"
                            1 => "I&#46; Ray-Coquard"
                            2 => "A&#46; Italiano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejca.2013.09.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cancer"
                        "fecha" => "2014"
                        "volumen" => "50"
                        "paginaInicial" => "128"
                        "paginaFinal" => "136"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24135684"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primary malignant cardiac tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46; Yu"
                            1 => "T&#46; Gu"
                            2 => "E&#46; Shi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00432-014-1651-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cancer Res Clin Oncol"
                        "fecha" => "2014"
                        "volumen" => "140"
                        "paginaInicial" => "1047"
                        "paginaFinal" => "1055"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24671225"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathological study of primary cardiac and pericardial tumors in a specialist UK centre&#58; surgical and autopsy series"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Patel"
                            1 => "M&#46; Sheppard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.carpath.2009.07.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cardiovasc Pathol"
                        "fecha" => "2010"
                        "volumen" => "19"
                        "paginaInicial" => "343"
                        "paginaFinal" => "352"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19747857"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primary cardiac sarcomas&#58; a clinicopathologic analysis of a series with follow-up information in 17 patients and emphasis on long-term survival"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; Zhang"
                            1 => "J&#46; Brooks"
                            2 => "J&#46; Goldblum"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.humpath.2008.01.019"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hum Pathol"
                        "fecha" => "2008"
                        "volumen" => "39"
                        "paginaInicial" => "1385"
                        "paginaFinal" => "1395"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18602663"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primary left atrial hemangioendothelioma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Messias"
                            1 => "J&#46; Bernardo"
                            2 => "M&#46;J&#46; Antunes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1510/icvts.2008.184085"
                      "Revista" => array:6 [
                        "tituloSerie" => "Interact Cardiovasc Thorac Surg"
                        "fecha" => "2008"
                        "volumen" => "7"
                        "paginaInicial" => "945"
                        "paginaFinal" => "946"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18635584"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac neoplasms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Blackman"
                            1 => "M&#46; Reardon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "titulo" => "Cardiac surgery in the adult"
                        "paginaInicial" => "1245"
                        "paginaFinal" => "1275"
                        "edicion" => "4th edition"
                        "serieFecha" => "2012"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21742049/0000003500000004/v2_201703300127/S2174204916000611/v2_201703300127/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9917"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003500000004/v2_201703300127/S2174204916000611/v2_201703300127/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916000611?idApp=UINPBA00004E"
]

Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2016.03.003

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	6	5	11
2024 October	33	27	60
2024 September	35	18	53
2024 August	39	25	64
2024 July	34	30	64
2024 June	38	32	70
2024 May	40	31	71
2024 April	20	19	39
2024 March	32	31	63
2024 February	20	29	49
2024 January	19	23	42
2023 December	22	26	48
2023 November	22	21	43
2023 October	26	17	43
2023 September	25	16	41
2023 August	17	17	34
2023 July	12	13	25
2023 June	16	7	23
2023 May	23	22	45
2023 April	9	3	12
2023 March	20	21	41
2023 February	19	22	41
2023 January	21	10	31
2022 December	30	20	50
2022 November	26	21	47
2022 October	16	20	36
2022 September	24	40	64
2022 August	19	22	41
2022 July	25	28	53
2022 June	22	18	40
2022 May	14	27	41
2022 April	20	31	51
2022 March	16	24	40
2022 February	20	22	42
2022 January	26	21	47
2021 December	24	21	45
2021 November	29	34	63
2021 October	35	30	65
2021 September	26	31	57
2021 August	26	28	54
2021 July	22	31	53
2021 June	24	13	37
2021 May	27	35	62
2021 April	31	55	86
2021 March	55	16	71
2021 February	33	19	52
2021 January	19	12	31
2020 December	29	11	40
2020 November	19	15	34
2020 October	17	15	32
2020 September	35	11	46
2020 August	14	7	21
2020 July	23	14	37
2020 June	22	2	24
2020 May	27	7	34
2020 April	35	6	41
2020 March	21	4	25
2020 February	42	13	55
2020 January	27	4	31
2019 December	26	3	29
2019 November	14	10	24
2019 October	30	6	36
2019 September	13	10	23
2019 August	18	3	21
2019 July	25	11	36
2019 June	15	6	21
2019 May	27	3	30
2019 April	23	9	32
2019 March	34	8	42
2019 February	34	10	44
2019 January	29	8	37
2018 December	46	11	57
2018 November	96	8	104
2018 October	212	18	230
2018 September	57	16	73
2018 August	23	1	24
2018 July	22	10	32
2018 June	28	5	33
2018 May	36	11	47
2018 April	38	7	45
2018 March	36	8	44
2018 February	16	7	23
2018 January	27	4	31
2017 December	55	8	63
2017 November	62	7	69
2017 October	39	12	51
2017 September	26	24	50
2017 August	36	11	47
2017 July	25	11	36
2017 June	31	14	45
2017 May	32	8	40
2017 April	15	3	18
2017 March	43	18	61
2017 February	26	3	29
2017 January	29	3	32
2016 December	29	14	43
2016 November	28	12	40
2016 October	33	22	55
2016 September	30	10	40
2016 August	7	1	8
2016 July	21	17	38
2016 June	18	23	41
2016 May	24	29	53
2016 April	13	14	27

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter