Case report
Understanding cardiac myxoma recurrence: A case report
Compreender a recorrência dos mixomas cardíacos – Um caso clínico
Maria Salomé Carvalhoa,
, Maria João Andradea, João Abecasisa, Rosa Gouveiab, Luísa Brancoc, José Pedro Nevesd, Miguel Mendesa
Autor para correspondência
a Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide, Oeiras, Portugal
b Serviço de Anatomia Patológica, Hospital de Santa Cruz, Carnaxide, Oeiras, Portugal
c Serviço de Cardiologia, Hospital de Santa Marta, Lisboa, Portugal
d Serviço de Cirurgia Cardiotorácica, Hospital de Santa Cruz, Carnaxide, Oeiras, Portugal
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residual atrial septum (B). *: right atrial mass; AS: atrial septum; RA: right atrium.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Myxomas are the most common primary cardiac tumors, representing 30–50% of cardiac neoplastic lesions identified in anatomopathological series. Although preferentially located in the left atrium, myxoma may also appear in the right atrium (up to 20% of cases), ventricular chambers and, rarely, on cardiac valves.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Its clinical behavior may be “malignant” with embolic events, valvular dysfunction and hemodynamic compromise.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Nevertheless these benign tumors are usually cured by surgery and synchronous and/or recurrent forms are rarely described, mainly in the context of familial syndromes.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">We report the case of a 38-year-old man referred to our institution for recurrence of a heart tumor. His history was negative for other cardiovascular problems or family history of heart disease and tumors. There was no evidence of Carney complex.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Three years previously he had undergone surgical removal of a large right atrial myxoma, detected on a transthoracic echocardiogram ordered because of fatigue, malaise, shortness of breath and chest tightness. The mass was described as fully occupying the right atrial cavity (68<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>53 mm in apical view), extending towards the opening of the inferior vena cava and prolapsing into the right ventricle, causing functional tricuspid valve stenosis. Transesophageal study located the stalk in the atrial septum.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Surgical excision was reported as complete, requiring extensive excision and reconstruction of the atrial septum with autologous pericardium.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Histopathology confirmed the diagnosis of a completely resected right atrial myxoma with free tumor margins. Follow-up transthoracic echocardiography after 12 months showed no right atrial mass.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Two years later, a redo routine echocardiographic evaluation revealed the presence of a new small spherical non-mobile right atrial mass (26<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>26 mm). Its echocardiographic appearance was soft, smooth, and homogeneous. It was located in a small recess near the inferior vena cava opening. Impaired venous return was suspected due to the absence of inferior vena cava respiratory variation, and flow acceleration at the confluence with the right atrium (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). Transesophageal echocardiography confirmed these findings and ruled out the presence of other tumor foci. Both the mass and the residual atrial septum were shown by Doppler imaging to be richly vascularized (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The patient underwent excision of the mass, which required venous and atrial septum reconstruction as a result of the broad base of tumor implantation.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Histopathological diagnosis was consistent with benign cardiac myxoma (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>A). A peculiar morphological aspect attracted the pathologist's attention: an increased number of vessels randomly located around the insertion area, with irregular contours, thick walls, and fibrointimal hyperplasia (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>B). At this point, a review of the slides from the first cardiac myxoma showed similar morphological features.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Twelve months after the second operation, the patient remains asymptomatic, without abnormal findings on follow-up transthoracic echocardiography.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">The estimated recurrence rate of sporadic myxoma is 2–3%.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> They usually appear during the first four years, although they can emerge within a few months to several years after surgical excision.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–9</span></a> Unlike primary myxoma, which is more frequent in women, tumor recurrence appears to be more frequent in men.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The first case of myxoma recurrence was described by Gerbode et al. in 1967, several years after the first surgical removal of such tumors.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> At that time, incomplete surgical resection was presumed to be the cause. Since then, several cases of tumor recurrence have been reported, not only after extensive excisions but also arising on the opposite side of the heart from the initial one.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Four different possible mechanisms have been put forward to explain recurrence: inadequate resection, totipotent multicentricity, inheritance (familial type), and metastatic recurrence.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5,12,13</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">There is some histopathological evidence of a tendency for increasing aggressiveness and possible malignant degeneration into forms of myxosarcoma.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,10</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Even though the mechanism of recurrence is difficult to confirm in an individual case, the possibility of a familial syndrome should always be considered. The presence of concurrent cardiac lesions and clinical features suggestive of syndromic association (such as hyperpigmentation, endocrine disease, or benign extracardiac connective tissue tumors) should raise the suspicion of familial transmission,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> for which causative mutations have been identified.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The unusual nature of this case lies in a less common location of the tumor (in the right atrium), and in its recurrence, considering this is a case of the sporadic form of the disease. Moreover, both echocardiography and histology provided evidence of marked vascularization, a feature seldom encountered in myxomas, but usually present in malignant lesions. In fact, the presence of these large vessels in the tumor base, pedicle, and surrounding structures could facilitate development and/or recurrence of a neoplastic mass, acting as stimuli for excessive growth and differentiation. A strong angiogenic potential driven by the release of VEGF by macrophages and the tumor cells, as well as autocrine activation of VEGF receptors on these cells, has been shown in cardiac myxoma, thereby perpetuating the angiogenic response within these tumors.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Abnormal blood supply might thus be an explanation for the oncogenic-like behavior of otherwise benign quiescent multicentric totipotent cells.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protection of human and animal subjects</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres250703" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec238293" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres250702" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec238294" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:3 [ "identificador" => "sec0020" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Right to privacy and informed consent" ] ] ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-05-18" "fechaAceptado" => "2012-05-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec238293" "palabras" => array:2 [ 0 => "Right atrial myxoma" 1 => "Recurrent cardiac myxoma" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec238294" "palabras" => array:2 [ 0 => "Mixoma do coração direito" 1 => "Mixoma recorrente" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Recurrence of cardiac myxoma is a rare condition, observed in about 3% of patients in sporadic cases, although it is more frequent in familial ones.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Several mechanisms have been proposed to explain such recurrence, and the importance of increased vascularization as a facilitating feature is the subject of debate.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The authors report the case of a non-familial right atrial myxoma, unusual for both its histopathology and recurrence.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A recorrência de mixomas cardíacos é rara, acontecendo em cerca de 3% dos doentes com mixomas esporádicos, embora seja mais frequente nos casos familiares.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Vários mecanismos foram propostos para explicar as recorrências e a importância da vascularização aumentada como fenómeno facilitador é controversa.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Os autores descrevem o caso de um mixoma esporádico do coração direito, peculiar pelas suas características histológicas e recorrência.</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" => 1026 "Ancho" => 1500 "Tamanyo" => 154921 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiography study showing a right atrial mass located near the inferior vena cava opening (A and B – non-conventional views, C – apical 4-chamber view, D – subcostal view) and flow acceleration at the confluence with the right atrium (B). *: right atrial mass; IVC: inferior vena cava; LA: left atrium; LV: left ventricle; RA: right atrium; RV: right ventricle.</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" => 552 "Ancho" => 1300 "Tamanyo" => 91632 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Transesophageal echocardiography study with color Doppler showing the rich vascularization of the mass (A) and of the residual atrial septum (B). *: right atrial mass; AS: atrial septum; RA: right atrium.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 557 "Ancho" => 1500 "Tamanyo" => 201411 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">(A) Conventional view of a cardiac myxoma (hematoxylin and eosin stain ×100). (B) Anomalous vascularization (elastic van Gieson stain ×40).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac myxomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K. Reynen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199512143332407" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1995" "volumen" => "333" "paginaInicial" => "1610" "paginaFinal" => "1617" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7477198" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac myxoma: a 13-year experience in echocardiographic diagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Oliveira" 1 => "L. Branco" 2 => "A. Galrinho" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2010" "volumen" => "29" "paginaInicial" => "1087" "paginaFinal" => "1100" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21066964" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0090825800958207" "estado" => "S300" "issn" => "00908258" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple recurrences of cardiac myxomas with acute tumoral pulmonary embolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "W. Manfroi" 1 => "S.R. Vieira" 2 => "E.K. Saadi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arq Bras Cardiol" "fecha" => "2001" "volumen" => "77" "paginaInicial" => "161" "paginaFinal" => "166" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11514827" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical treatment of cardiac tumors: a 25-year experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.C. Murphy" 1 => "M.S. Sweeny" 2 => "J.B. Putnam" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "1990" "volumen" => "49" "paginaInicial" => "612" "paginaFinal" => "618" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2322057" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurrent cardiac myxoma: seeding or multifocal disease?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Shinfeld" 1 => "T. Katsumata" 2 => "S. Westaby" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "1998" "volumen" => "66" "paginaInicial" => "285" "paginaFinal" => "288" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9692493" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac myxoma: its origin and tumor characteristics" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Amano" 1 => "T. Kono" 2 => "Y. Wada" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Ann Thorac Cardiovasc Surg" "fecha" => "2003" "volumen" => "9" "itemHostRev" => array:3 [ "pii" => "S0090825811009346" "estado" => "S300" "issn" => "00908258" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical treatment of primary intracardiac myxoma: 19 years of experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Samanidis" 1 => "K. Perreas" 2 => "P. Kalogris" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Interactive Cardiovasc Thorac Surg" "fecha" => "2011" "volumen" => "13" "paginaInicial" => "597" "paginaFinal" => "600" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac myxomas: clinical and echocardiographic profile" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K.C. Goswami" 1 => "S. Shrivastava" 2 => "V.K. Bahl" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "1998" "volumen" => "63" "paginaInicial" => "251" "paginaFinal" => "259" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9578352" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurrent multiple cardiac myxomas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Yavuz" 1 => "C. Eris" 2 => "M. Sezen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Bratisl Lek Listy" "fecha" => "2010" "volumen" => "111" "paginaInicial" => "549" "paginaFinal" => "551" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21125800" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurring cardiac myxoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "I. Gray" 1 => "W. Williams" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br Heart J" "fecha" => "1985" "volumen" => "53" "paginaInicial" => "645" "paginaFinal" => "649" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4005088" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical management of tumors of the heart" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Gerbode" 1 => "W.J. Kerth" 2 => "J.D. Hill" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Surgery" "fecha" => "1967" "volumen" => "61" "paginaInicial" => "94" "paginaFinal" => "101" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6016669" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple recurrence of a “sporadic” (non-familial) cardiac myxoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Aroca" 1 => "J.M. Mesa" 2 => "F. Dominguez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "1996" "volumen" => "10" "paginaInicial" => "919" "paginaFinal" => "921" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8911849" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurrent cardiac myxoma: why it occurs. A case report with literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Reber" 1 => "D.E. Birnbaum" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Cardiovasc Surg (Torino)" "fecha" => "2001" "volumen" => "42" "paginaInicial" => "345" "paginaFinal" => "348" "itemHostRev" => array:3 [ "pii" => "S0140673605664550" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The CNC gene PRKAR1A plays an essential role in cardiac development and myxomagenesis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.S. Kirschner" 1 => "Z. Yin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.tcm.2009.04.005" "Revista" => array:6 [ "tituloSerie" => "Trends Cardiovasc Med" "fecha" => "2009" "volumen" => "19" "paginaInicial" => "44" "paginaFinal" => "49" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19577711" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carney complex: clinical and genetic 2010 update" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Vezzosi" 1 => "O. Vignaux" 2 => "N. Dupin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Endocrinol (Paris)" "fecha" => "2010" "volumen" => "71" "paginaInicial" => "486" "paginaFinal" => "493" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of tumor vascularisation in benign and malignant cardiovascular neoplasms: a comparison of cardiac myxoma and sarcomas of the pulmonary artery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Gaumann" 1 => "G. Strubel" 2 => "B. Bode-Lesniewska" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Oncol Rep" "fecha" => "2008" "volumen" => "20" "paginaInicial" => "309" "paginaFinal" => "318" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18636191" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003200000003/v1_201308021313/S0870255113000267/v1_201308021313/en/main.assets" "Apartado" => array:4 [ "identificador" => "362" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Casos clínicos" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003200000003/v1_201308021313/S0870255113000267/v1_201308021313/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255113000267?idApp=UINPBA00004E" ]
| Ano/Mês | Html | Total | |
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| 2023 Julho | 41 | 15 | 56 |
| 2023 Junho | 39 | 11 | 50 |
| 2023 Maio | 52 | 26 | 78 |
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| 2023 Maro | 45 | 18 | 63 |
| 2023 Fevereiro | 29 | 22 | 51 |
| 2023 Janeiro | 40 | 18 | 58 |
| 2022 Dezembro | 47 | 16 | 63 |
| 2022 Novembro | 56 | 26 | 82 |
| 2022 Outubro | 44 | 14 | 58 |
| 2022 Setembro | 28 | 31 | 59 |
| 2022 Agosto | 34 | 34 | 68 |
| 2022 Julho | 42 | 37 | 79 |
| 2022 Junho | 32 | 18 | 50 |
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| 2020 Maio | 49 | 3 | 52 |
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| 2020 Maro | 55 | 7 | 62 |
| 2020 Fevereiro | 111 | 9 | 120 |
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| 2019 Setembro | 61 | 14 | 75 |
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| 2019 Fevereiro | 44 | 11 | 55 |
| 2019 Janeiro | 39 | 4 | 43 |
| 2018 Dezembro | 57 | 13 | 70 |
| 2018 Novembro | 111 | 5 | 116 |
| 2018 Outubro | 167 | 17 | 184 |
| 2018 Setembro | 59 | 9 | 68 |
| 2018 Agosto | 61 | 13 | 74 |
| 2018 Julho | 50 | 4 | 54 |
| 2018 Junho | 83 | 11 | 94 |
| 2018 Maio | 135 | 9 | 144 |
| 2018 Abril | 108 | 6 | 114 |
| 2018 Maro | 121 | 11 | 132 |
| 2018 Fevereiro | 105 | 3 | 108 |
| 2018 Janeiro | 80 | 8 | 88 |
| 2017 Dezembro | 132 | 11 | 143 |
| 2017 Novembro | 59 | 13 | 72 |
| 2017 Outubro | 58 | 11 | 69 |
| 2017 Setembro | 63 | 8 | 71 |
| 2017 Agosto | 59 | 14 | 73 |
| 2017 Julho | 36 | 8 | 44 |
| 2017 Junho | 58 | 14 | 72 |
| 2017 Maio | 99 | 9 | 108 |
| 2017 Abril | 30 | 37 | 67 |
| 2017 Maro | 34 | 12 | 46 |
| 2017 Fevereiro | 43 | 6 | 49 |
| 2017 Janeiro | 34 | 4 | 38 |
| 2016 Dezembro | 47 | 11 | 58 |
| 2016 Novembro | 78 | 12 | 90 |
| 2016 Outubro | 68 | 19 | 87 |
| 2016 Setembro | 37 | 16 | 53 |
| 2016 Agosto | 19 | 7 | 26 |
| 2016 Julho | 9 | 11 | 20 |
| 2016 Junho | 9 | 12 | 21 |
| 2016 Maio | 29 | 7 | 36 |
| 2016 Abril | 79 | 3 | 82 |
| 2016 Maro | 114 | 11 | 125 |
| 2016 Fevereiro | 149 | 24 | 173 |
| 2016 Janeiro | 110 | 9 | 119 |
| 2015 Dezembro | 122 | 9 | 131 |
| 2015 Novembro | 98 | 7 | 105 |
| 2015 Outubro | 125 | 13 | 138 |
| 2015 Setembro | 112 | 14 | 126 |
| 2015 Agosto | 104 | 17 | 121 |
| 2015 Julho | 107 | 11 | 118 |
| 2015 Junho | 83 | 5 | 88 |
| 2015 Maio | 94 | 11 | 105 |
| 2015 Abril | 86 | 8 | 94 |
| 2015 Maro | 94 | 9 | 103 |
| 2015 Fevereiro | 69 | 9 | 78 |
| 2015 Janeiro | 69 | 6 | 75 |
| 2014 Dezembro | 77 | 16 | 93 |
| 2014 Novembro | 76 | 9 | 85 |
| 2014 Outubro | 115 | 16 | 131 |
| 2014 Setembro | 82 | 10 | 92 |
| 2014 Agosto | 86 | 8 | 94 |
| 2014 Julho | 98 | 13 | 111 |
| 2014 Junho | 105 | 8 | 113 |
| 2014 Maio | 106 | 8 | 114 |
| 2014 Abril | 92 | 12 | 104 |
| 2014 Maro | 110 | 19 | 129 |
| 2014 Fevereiro | 90 | 14 | 104 |
| 2014 Janeiro | 97 | 13 | 110 |
| 2013 Dezembro | 92 | 16 | 108 |
| 2013 Novembro | 90 | 19 | 109 |
| 2013 Outubro | 80 | 20 | 100 |
| 2013 Setembro | 84 | 18 | 102 |
| 2013 Agosto | 84 | 21 | 105 |
| 2013 Julho | 71 | 27 | 98 |
| 2013 Junho | 73 | 19 | 92 |
| 2013 Maio | 65 | 30 | 95 |
| 2013 Abril | 115 | 65 | 180 |
| 2013 Maro | 55 | 39 | 94 |
Mostrar tudo
