Clinical characteristics and outcomes of pediatric cardiac masses: A 20-year retrospective single-center experience

Background: Intracardiac masses in children are rare and encompass a spectrum of benign and malignant lesions. Rhabdomyomas are the most frequent and are commonly associated with tuberous sclerosis complex. Advances in imaging have improved early detection, yet the natural history and management strategies remain heterogeneous. Aims: To evaluate the clinical characteristics, diagnostic approaches, long-term follow-up, and outcomes of pediatric patients diagnosed with cardiac masses over a 20-year period. Methods: A retrospective, single-center study conducted at a tertiary pediatric cardiology unit between 2003 and 2023. Medical records of 33 patients under 18 years of age with echocardiographically or histologically confirmed intracardiac masses were reviewed. Data on demographics, clinical presentation, imaging findings, mass characteristics, management, and outcomes were collected. Descriptive statistics were performed; categorical variables were expressed as percentages, and continuous variables as mean ± SD or median (IQR). Results: Rhabdomyomas were identified in 57.6% of patients-all associated with tuberous sclerosis-while fibromas accounted for 9.1% and 33.3% had undetermined histology. Left ventricular involvement was most frequent (54%). Thirty-nine percent were asymptomatic, diagnosed incidentally during screening. Surgical resection was required in three patients, with one postoperative death. During follow-up, 42% of rhabdomyomas regressed spontaneously, whereas 66% of fibromas were excised. Masses of unknown type mostly remained stable. Conclusions: Pediatric cardiac tumors are predominantly benign and often managed conservatively. Rhabdomyomas should prompt evaluation for tuberous sclerosis, especially when multiple lesions are present prenatally. Echocardiography remains the cornerstone of diagnosis and follow-up, while MRI and PET-CT provide valuable complementary data.