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
Corresponding author
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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"mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1715 "Ancho" => 2500 "Tamanyo" => 267027 ] ] "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>" ] ] ] "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" => "xres177689" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec166339" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres177688" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec166338" "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" => "xpalclavsec166339" "palabras" => array:2 [ 0 => "Right atrial myxoma" 1 => "Recurrent cardiac myxoma" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec166338" "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" => 1715 "Ancho" => 2500 "Tamanyo" => 267027 ] ] "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" => 924 "Ancho" => 2174 "Tamanyo" => 153153 ] ] "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" => 931 "Ancho" => 2500 "Tamanyo" => 316933 ] ] "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:6 [ "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" ] ] ] ] ] ] ] ] 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:3 [ "tituloSerie" => "Ann Thorac Cardiovasc Surg" "fecha" => "2003" "volumen" => "9" ] ] ] ] ] ] 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:5 [ "tituloSerie" => "J Cardiovasc Surg (Torino)" "fecha" => "2001" "volumen" => "42" "paginaInicial" => "345" "paginaFinal" => "348" ] ] ] ] ] ] 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" => "/21742049/0000003200000003/v1_201305171232/S217420491300072X/v1_201305171232/en/main.assets" "Apartado" => array:4 [ "identificador" => "9919" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003200000003/v1_201305171232/S217420491300072X/v1_201305171232/en/main.pdf?idApp=UINPBA00004E&text.app=https://www.revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491300072X?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 0 | 1 | 1 |
| 2024 October | 30 | 29 | 59 |
| 2024 September | 42 | 19 | 61 |
| 2024 August | 43 | 26 | 69 |
| 2024 July | 32 | 27 | 59 |
| 2024 June | 26 | 14 | 40 |
| 2024 May | 35 | 18 | 53 |
| 2024 April | 29 | 23 | 52 |
| 2024 March | 28 | 23 | 51 |
| 2024 February | 25 | 33 | 58 |
| 2024 January | 22 | 36 | 58 |
| 2023 December | 17 | 24 | 41 |
| 2023 November | 29 | 19 | 48 |
| 2023 October | 30 | 16 | 46 |
| 2023 September | 23 | 21 | 44 |
| 2023 August | 23 | 19 | 42 |
| 2023 July | 19 | 10 | 29 |
| 2023 June | 31 | 19 | 50 |
| 2023 May | 31 | 19 | 50 |
| 2023 April | 13 | 4 | 17 |
| 2023 March | 25 | 22 | 47 |
| 2023 February | 21 | 22 | 43 |
| 2023 January | 26 | 14 | 40 |
| 2022 December | 22 | 27 | 49 |
| 2022 November | 29 | 20 | 49 |
| 2022 October | 24 | 22 | 46 |
| 2022 September | 21 | 20 | 41 |
| 2022 August | 20 | 42 | 62 |
| 2022 July | 23 | 34 | 57 |
| 2022 June | 14 | 20 | 34 |
| 2022 May | 42 | 29 | 71 |
| 2022 April | 31 | 23 | 54 |
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| 2021 December | 14 | 24 | 38 |
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| 2021 October | 28 | 46 | 74 |
| 2021 September | 21 | 31 | 52 |
| 2021 August | 30 | 28 | 58 |
| 2021 July | 24 | 32 | 56 |
| 2021 June | 30 | 18 | 48 |
| 2021 May | 37 | 39 | 76 |
| 2021 April | 51 | 28 | 79 |
| 2021 March | 56 | 22 | 78 |
| 2021 February | 35 | 10 | 45 |
| 2021 January | 13 | 6 | 19 |
| 2020 December | 33 | 6 | 39 |
| 2020 November | 21 | 15 | 36 |
| 2020 October | 9 | 6 | 15 |
| 2020 September | 53 | 9 | 62 |
| 2020 August | 16 | 7 | 23 |
| 2020 July | 27 | 3 | 30 |
| 2020 June | 33 | 5 | 38 |
| 2020 May | 42 | 4 | 46 |
| 2020 April | 28 | 8 | 36 |
| 2020 March | 38 | 6 | 44 |
| 2020 February | 76 | 19 | 95 |
| 2020 January | 32 | 6 | 38 |
| 2019 December | 22 | 3 | 25 |
| 2019 November | 29 | 5 | 34 |
| 2019 October | 37 | 3 | 40 |
| 2019 September | 18 | 13 | 31 |
| 2019 August | 38 | 5 | 43 |
| 2019 July | 33 | 11 | 44 |
| 2019 June | 17 | 7 | 24 |
| 2019 May | 33 | 9 | 42 |
| 2019 April | 13 | 11 | 24 |
| 2019 March | 116 | 9 | 125 |
| 2019 February | 93 | 7 | 100 |
| 2019 January | 61 | 8 | 69 |
| 2018 December | 62 | 7 | 69 |
| 2018 November | 82 | 5 | 87 |
| 2018 October | 167 | 10 | 177 |
| 2018 September | 53 | 9 | 62 |
| 2018 August | 40 | 5 | 45 |
| 2018 July | 57 | 6 | 63 |
| 2018 June | 54 | 8 | 62 |
| 2018 May | 94 | 4 | 98 |
| 2018 April | 68 | 6 | 74 |
| 2018 March | 86 | 6 | 92 |
| 2018 February | 70 | 4 | 74 |
| 2018 January | 41 | 4 | 45 |
| 2017 December | 155 | 8 | 163 |
| 2017 November | 27 | 7 | 34 |
| 2017 October | 29 | 6 | 35 |
| 2017 September | 40 | 6 | 46 |
| 2017 August | 36 | 14 | 50 |
| 2017 July | 29 | 8 | 37 |
| 2017 June | 32 | 7 | 39 |
| 2017 May | 37 | 8 | 45 |
| 2017 April | 34 | 8 | 42 |
| 2017 March | 38 | 6 | 44 |
| 2017 February | 76 | 6 | 82 |
| 2017 January | 52 | 2 | 54 |
| 2016 December | 58 | 10 | 68 |
| 2016 November | 30 | 4 | 34 |
| 2016 October | 69 | 4 | 73 |
| 2016 September | 152 | 14 | 166 |
| 2016 August | 11 | 4 | 15 |
| 2016 July | 10 | 4 | 14 |
| 2016 June | 7 | 4 | 11 |
| 2016 May | 14 | 2 | 16 |
| 2016 April | 26 | 1 | 27 |
| 2016 March | 24 | 3 | 27 |
| 2016 February | 34 | 18 | 52 |
| 2016 January | 29 | 2 | 31 |
| 2015 December | 27 | 5 | 32 |
| 2015 November | 29 | 4 | 33 |
| 2015 October | 27 | 5 | 32 |
| 2015 September | 24 | 8 | 32 |
| 2015 August | 39 | 8 | 47 |
| 2015 July | 34 | 5 | 39 |
| 2015 June | 13 | 0 | 13 |
| 2015 May | 20 | 4 | 24 |
| 2015 April | 21 | 7 | 28 |
| 2015 March | 13 | 4 | 17 |
| 2015 February | 21 | 5 | 26 |
| 2015 January | 18 | 7 | 25 |
| 2014 December | 32 | 8 | 40 |
| 2014 November | 19 | 5 | 24 |
| 2014 October | 21 | 3 | 24 |
| 2014 September | 21 | 8 | 29 |
| 2014 August | 21 | 4 | 25 |
| 2014 July | 30 | 7 | 37 |
| 2014 June | 18 | 3 | 21 |
| 2014 May | 27 | 6 | 33 |
| 2014 April | 23 | 1 | 24 |
| 2014 March | 32 | 12 | 44 |
| 2014 February | 29 | 4 | 33 |
| 2014 January | 39 | 11 | 50 |
| 2013 December | 35 | 5 | 40 |
| 2013 November | 26 | 7 | 33 |
| 2013 October | 30 | 8 | 38 |
| 2013 September | 39 | 12 | 51 |
| 2013 August | 51 | 13 | 64 |
| 2013 July | 51 | 11 | 62 |
| 2013 June | 26 | 8 | 34 |
| 2013 May | 37 | 7 | 44 |
| 2013 April | 6 | 2 | 8 |
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