心脏原发非黏液性肿瘤的超声诊断及分析(附11例报告)

对11例心脏原发性非黏液性肿瘤患者的临床资料及超声表现进行分析，并与手术和病理结果进行对比，肿瘤为良性6例，恶性5例；累及右心系统6例，左心系统5例，心包2例，各种心脏原发性肿瘤均具有特征性的声像图特点。超声心动图对心脏原发性非黏液性肿瘤有较高的诊断准确性。     

78例心脏原发肿瘤手术治疗的临床经验

目的总结78例心脏原发肿瘤患者手术治疗的临床经验。方法1985年1月至2007年3月,78例心脏原发肿瘤患者在我院接受诊断和手术治疗。心脏原发肿瘤分为3类:黏液瘤、良性非黏液性肿瘤及恶性肿瘤。对生存者进行随访,平均随访(7±5)年。结果本组心脏原发肿瘤共78例。70例为良性肿瘤:黏液瘤65例(83.33%),良性非黏液性肿瘤5例(6.41%);恶性肿瘤8例(10.26%)。心脏良性肿瘤组住院死亡率为1.49%(1例,良性非黏液性肿瘤组),恶性肿瘤组无住院死亡。结论手术是心脏原发肿瘤的首选治疗方法,心脏良性肿瘤可以通过手术治疗达到治愈,手术可以缓解恶性肿瘤的临床症状。     

原发性心脏肿瘤的超声诊断价值与分析

目的探讨原发性心脏肿瘤的超声心动图特征与临床诊断价值。方法回顾性分析我院62例原发性心脏肿瘤患者的临床资料,将超声检查结果与手术病理结果对照。结果术前超声心动图对54例黏液瘤做出正确诊断;1例右室黏液瘤及良性非黏液性肿瘤、恶性肿瘤均提示相应部位占位性病变。黏液瘤多位于左房,有蒂,多附着于房间隔,活动度大,包膜完整,与心肌分界清,少复发;而恶性肿瘤多无蒂,活动度小,包膜不完整,与心肌分界不清,易复发。结论超声心动图对原发心脏肿瘤的诊断与鉴别诊断具有较大的价值。     

外科治疗56例心脏非黏液性肿瘤的临床分析

目的探讨心脏非黏液性肿瘤临床特点,总结外科治疗经验。方法对我院1996年10月至2005年3月进行外科治疗的56例心脏非黏液性肿瘤的临床资料进行回顾性分析,总结其临床表现、发生部位、肿瘤性质和外科治疗特点等。结果心脏非粘液性肿瘤占本院同期手术患者的0.14%,良性肿瘤28例,恶性肿瘤28例,其中继发性心脏肿瘤8例。良性肿瘤最常见的是生长在心室,共18例;恶性肿瘤最常见的生长部位是心房,共15例。外科治疗行急诊手术者12例。心包开窗引流术2例,探查术1例,术中肿瘤全部切除者26例,部分切除27例,术后住院期间死亡1例。结论心脏非黏液性肿瘤临床表现各异、病理类型多样、病变广泛,手术原则为尽可能切除肿瘤和保持心脏结构的完整性和功能。     

心外科患者中心脏肿瘤的流行病学研究

目的:总结心脏肿瘤的流行病学特征,提高对心脏肿瘤的认识。方法:回顾性分析了自1996年10月～2005年3月我院行心脏手术治疗的242例心脏肿瘤患者的年龄分布、性别特征、肿瘤性质、生长部位和特点等。结果:在行心脏外科治疗的患者中,心脏肿瘤发生率为0.75%。良性肿瘤构成比为88.0%,以黏液瘤为主,高于恶性肿瘤(11.2%)(P<0.01)。不同年龄发生率也不同,40～49岁年龄段发生率最高,达30%,其次为50～59岁年龄段(26.8%)。黏液瘤女性发生率高于男性(P<0.01),这一现象在非黏液瘤患者中不明显。左心系统恶性肿瘤比例为5.3%,右心系统恶性肿瘤比例为28.6%,8例继发性心脏肿瘤均发生于右心系统,侵犯多房室的肿瘤恶性比例为75%。结论:经外科治疗的心脏肿瘤发生率占心脏外科患者的0.75%,多数为原发良性肿瘤。     

原发性非黏液性心脏肿瘤六例临床分析

心脏黏液瘤是最常见的心脏肿瘤,而非黏液性肿瘤较为少见,我院自2003年至2007年共诊治6例非黏液性心脏肿瘤,现将其病例资料进行回顾性分析,以积累更多的心脏肿瘤诊治经验.     

以室性心动过速为首发临床表现的心脏肿瘤五例

目的 总结以室性心动过速为首发表现的心脏肿瘤的临床和心电图特点，以利及时诊断。方法 对１９９２年１２月～１９９９年７月收治的５例以室性心动过速为首发表现，后经影像学检查发现并经手术和病理证实的心脏肿瘤患者的临床和心电图特点进行分析。结果 本组５例均以室性心动过速为首发临床表现。心室率１６０～２０００次／ｍｉｎ，其中，伴一过性头晕３例，黑Ｍｅｎｇ２例，临床无其他症状和体征。既往均无心脏病史，而且肿瘤的所在实际部位与心电图所显示的室性期前收缩，乃至室性心动过速起源部位基本一致，其中１例经心内电生理证实，结论 对临床上以室性心动过速为主要表现的患者，应考虑到有心脏肿瘤的可能。应行影像学检查确诊。常规心电图所显示的室性心动过速的起源部位对心脏肿瘤有一定的定位价值。     

心脏黏液瘤的外科诊治分析

目的 探讨心脏黏液瘤的外科治疗的临床要素.方法 回顾性分析92例心脏黏液瘤患者的临床资料并复习相关文献.结果 1997年至2012年收治经手术治疗和病理证实的心脏黏液瘤患者92例,男性38例,女性54例,年龄4～67岁,病史1个月至5年;其中左房黏液瘤80例,右房黏液瘤6例,双心房黏液瘤2例,右心室黏液瘤3例,左心室黏液瘤1例.术前均由超声心动图确诊,在全麻体外循环下手术摘除黏液瘤.同期行二尖瓣成形、二尖瓣置换术各3例,三尖瓣成形6例.术前诊断率100％.所有患者均治愈出院.87例经随访,随访时间3个月至5年2个月,复发1例.结论 心脏黏液瘤是最常见的心脏肿瘤,手术治疗效果确切.把握手术时机、避免肿瘤脱落引起栓塞等并发症的发生是手术成功的重要因素.超声心动图对诊断及随访均具有重要意义.     

186例原发性心脏肿瘤临床分析

目的总结原发性心脏肿瘤的临床特征。方法对接受手术治疗的186例原发性心脏肿瘤患者的临床资料作回顾性分析。结果本组原发性心脏肿瘤患者以41～50岁为高发年龄区段;首发症状以心悸、气短最为常见;右心恶性肿瘤比例高于左心(P<0.05)。心脏肿瘤为良性者占95.7%,其中黏液瘤占91.9%,均经心脏超声检查确诊,171例黏液瘤手术切除。左、右心肿瘤患者病死率、复发率相比差异有统计学意义(P均<0.05);黏液瘤组复发率、远期病死率低于恶性肿瘤组(P均<0.05)。结论原发性心脏肿瘤多数为左房黏液瘤,缺乏特征性临床表现;心脏超声检查是术前诊断心脏肿瘤的最佳手段,右心系统肿瘤中恶性肿瘤比例高;手术切除是原发性心脏肿瘤的首选治疗方法,其预后取决于肿瘤的病理类型及浸润范围。     

26例胃肠道间质瘤肝转移的临床特征和生存分析

目的 总结胃肠道间质瘤肝转移的临床病理特征，行生存分析，对诊断和治疗原则进行探讨。方法 收集本院收治的资料完整的胃肠道间质瘤患者99例，对其中26例肝转移患者的临床病理特征进行回顺性分析，探讨肝转移发生后生存时间的影响因素。结果 原发肿瘤和发生肝转移的平均年龄为50．8和51．8岁。病理证实者5例，手术中探查诊断为肝转移者12例，14例为单纯影像学诊断。发现原发肿瘤的同时和非同时伴肝转移者分别为8例和18例，非同时发现者肝转移距原发肿瘤手术时间的中位时间为12个月。肿瘤原发于胃12例．结直肠5例，小肠6例，胃肠道外3例。肝转移灶切除者4例，无水乙醇注射2例，介入治疗3例，全身静脉化疗7例，伊马替尼（格列卫）治疗8例，未治疗2例。肝转移后中位生存时间为21个月。伊马替尼治疗为影响肝转移后生存时间的重要因素。结论 原发部位为胃的胃肠道间质瘤肝转移最常见；小肠问质瘤易发生肝转移；服用伊马替尼3个月以上可延长生存。     

心脏心包非粘液瘤性原发性肿瘤的磁共振诊断--14例手术病理对照

目的 :分析心脏心包非粘液瘤性原发性肿瘤磁共振成像 (MRI)的影像学特征 ,评估其临床价值。　　方法 :收集经手术病理证实的原发性非粘液瘤性心脏心包肿瘤 14例 ,行 MRI自旋回波多体位扫描及磁共振电影检查。　　结果 :14例 MRI所见肿瘤部位、大小、扩展范围与外科和 (或 )大体病理所见几近一致 ,其中 9例定性诊断正确 ,包括脂肪瘤 3例、纤维瘤 2例和心包囊肿伴出血 4例。　　结论 :MRI软组织分辨率高 ,其大视野更有助于显示肿瘤与周围结构 (如纵隔、肺和膈肌等 )的关系 ;MRI电影则可补充一些解剖资料 ,显示血流动态变化。同时 MRI尚有助于对脂肪瘤、纤维瘤和心包囊肿伴出血等做出初步的定性诊断。     

Benign tumors of the heart (excluding myxoma). Experience with 9 surgically treated cases

Benign non myxomatous cardiac tumors are rare. Between 1968 and 1988, 9 patients presenting benign non myxomatous cardiac tumors were operated in our institution. Tumors were: 2 rhabdomyomas, 2 lipomas, 2 fibromas, 1 pheochromocytomas, 1 mesothelioma and 1 papillary fibroelastoma. Total excision was possible in all cases but one (multiple fibromas). We hereby present a review of the literature on the subject. We focalize on the new imagery techniques in order to help the diagnosis and on the new surgical possibilities (cardiomyoplasty) which make possible complete surgical excision.     

Primary myxomatous degeneration of cardiac valves. Clinical, pathological, haemodynamic, and echocardiographic profile.

Four hundred and ninety-nine surgically excised valves were examined for pathological evidence of myxomatous degeneration. Thirty-six valves (7%) had myxomatous degeneration as a major pathological finding. Fourteen valves (3%) had significant myxomatous degeneration of the pars fibrosa, a finding which we define as "primary myxomatous degeneration". Echocardiographic findings and catheterisation results were correlated with the clinical course, surgical results, and follow-up in these 14 patients. Echocardiograms in 10 of the 11 patients who had them (91%) showed abnormalities suggesting the presence of primary myxomatous degeneration. Echocardiography was more helpful than angiography in diagnosis. The histological pattern of primary mitral myxomatous degeneration appears to be identical to that seen in patients with mitral valve prolapse and five of six patients with mitral lesions had echocardiographic evidence of prolapse. None of the patients with primary myxomatous degeneration of the aortic valve had syphilis of Marfan's syndrome. While the aetiology of primary myxomatous degeneration of cardiac valves is not known, a link to a more generalised disorder is suggested.     

163例心脏肿瘤临床分析

目的 :总结心脏肿瘤的临床特征 ,提高对心脏肿瘤的认识。方法 :回顾性分析了 163例心脏肿瘤的临床表现、肿瘤发生部位及肿瘤性质等。结果 :心脏肿瘤最常见临床表现是心悸和气短。心脏肿瘤可发生于心脏任何部位 ,左心房最常见 ,且多为粘液瘤 ,其次是右心房。右心肿瘤除粘液瘤外 ,多为恶性肿瘤。 163例心脏肿瘤中原发性肿瘤 15 9例 (97.5 % ) ,其中粘液瘤 12 8例(78.5 % ) ,非粘液良性肿瘤 17例 (10 .4% ) ,恶性肿瘤 18(11.0 % )。结论 :原发心脏肿瘤中左心房粘液瘤最多见 ,良性心脏肿瘤手术治疗效果好 ,恶性心脏肿瘤预后差。     

Cardiac autotransplantation for malignant or complex primary left-heart tumors

Malignant or complex benign tumors of the left heart can present a formidable challenge for complete resection, due to anatomic inaccessibility. Cardiac autotransplantation (cardiac explantation, ex-vivo tumor resection, reconstruction, and reimplantation) was introduced for complex benign primary left-heart cardiac tumors by Cooley and for malignant left-heart tumors by Reardon. Herein, we update our previously reported experience.From April 1998 through July 2008, 20 patients underwent 21 cardiac autotransplantations for complex left-sided cardiac tumors that were nonresectable by traditional means. Demographics, tumor histology, operative data, and mortality rates were analyzed. Follow-up was complete in all patients.Of the 20 patients, 17 had malignant lesions, and 3 had benign disease. Two patients had left ventricular lesions and the rest had left atrial lesions. Histology showed 7 malignant fibrous histiocytomas, 5 undifferentiated sarcomas, 3 leiomyosarcomas, 1 malignant osteosarcoma, 1 myxoid sarcoma, 2 paragangliomas, and 1 myxoma. Fourteen patients had previous resection of their cardiac tumors, and 1 patient had repeat autotransplantation for recurrent disease. There were no operative deaths in patients undergoing autotransplantation alone (0/15), and 3 operative deaths in patients undergoing combined cardiac autotransplantation and pneumonectomy (3/6, 50%). All 3 patients with benign disease survived surgery and are alive without recurrent disease. Local recurrence occurred in 3/18 patients with malignant disease: 1 underwent successful repeat autotransplantation and 2 are receiving chemotherapy. The mean survival for all patients with sarcoma is 22 months.Cardiac autotransplantation enables complete resection and accurate reconstruction in many primary malignant and complex benign left-heart tumors.     

93例原发性心脏肿瘤的临床特点及手术治疗效果分析

目的：总结原发性心脏肿瘤的临床特点及手术治疗效果。方法：选择2000年1月-2010年6月手术治疗的93例原发性心脏肿瘤患者进行回顾性分析。结果：根据病理分型为：良性粘液型77例,占82．8％,良性非粘液型6例,占6．5％,恶性肿瘤10例,占10．7％。88例患者患者仍存活,2例患者于术后8个月、12个月死亡,3例患者于术后2年10个月后死亡。结论：原发性心脏肿瘤临床少见,一旦明确诊断,应立即手术,良性肿瘤效果较好,恶性肿瘤手术效果差。     

Therapy for primary cardiac tumors: is there a role for heart transplantation?

Primary cardiac tumors are rare clinical entities. Benign tumors are often amenable to surgical excision, whereas malignant tumors are seldom resectable. The literature has reported that 28 patients have undergone orthotopic heart transplantation for inoperable primary cardiac tumors. The results of these transplants are presented in this article. Of the 28 patients who underwent orthotopic heart transplantation for primary cardiac neoplasms, 7 patients had benign histology (fibroma-5, rhabdomyoma-1, and pheochromocytoma-1) and 21 patients had malignant histology (sarcoma-15, malignant fibrohistiocytoma-3, and lymphoma-3). Mean survival in the patients with benign histology was 46 months, and the mean survival in the patients with malignant histology was 12 months. However, there were seven patients with malignant histology who had survived for a mean of 27 months without evidence of recurrent disease. An awareness by clinicians of the presenting clinical picture of these tumors is warranted in view of the potential for cure by resection or transplantation. Patients with benign primary cardiac tumors appear to benefit from the complete resection afforded by cardiectomy and transplantation. The role of transplantation for patients with malignant tumors remains unclear. Further experience and continued follow-up of these patients is necessary to ascertain the role of cardiac transplantation, radiation, and chemotherapy in the management of patients with primary tumors of the heart.     

34例原发性心脏肿瘤的诊断及外科治疗

目的:探讨原发性心脏肿瘤的临床特征及外科治疗。方法:本院1997年5月至2010年5月,手术治疗原发性心脏肿瘤34例。其中良性肿瘤28例,恶性肿瘤6例。术前均经彩色超声心动图并结合CT、MRI明确诊断。结果:所有患者均在体外循环下施行肿瘤切除,33例痊愈出院,1例死亡。痊愈患者28例良性肿瘤,随访6个月至10年未见复发。5例心脏恶性肿瘤,随访3个月至6个月,3例术后复发,2例死亡。结论:原发性心脏肿瘤,因随时可能发生栓塞,甚至猝死。由于恶性肿瘤进展较快,应早期手术并结合综合性治疗以改善预后。     

A retrospective analysis of 3954 patients in phase 2/3 trials of bortezomib for the treatment of multiple myeloma: towards providing a benchmark for the cardiac safety profile of proteasome inhibition in multiple myeloma

This retrospective analysis aimed to establish the overall cardiac safety profile of bortezomib using patient‐level data from one phase 2 and seven phase 3 studies in previously untreated and relapsed/refractory multiple myeloma (MM). Seven clinically relevant primary [congestive heart failure (CHF), arrhythmias, ischaemic heart disease (IHD), cardiac death] and secondary (hypertension, dyspnoea, oedema) cardiac endpoints were defined based on MedDRA v16.0 preferred terms. 2509 bortezomib‐treated patients and 1445 patients in non‐bortezomib‐based control arms were included. The incidence of grade ≥3 CHF was 1·3–4·0% in studies in relapsed/refractory MM and 1·2–4·7% in previously untreated MM (2·0–7·6% all grades), with no significant differences between bortezomib‐ and non‐bortezomib‐based arms in comparative studies. Incidences of arrhythmias (1·3–5·9% grade ≥2; 0·6–4·1% grade ≥3), IHD (1·2–2·9% all grades; 0·4–2·7% grade ≥3) and cardiac death (0–1·4%) were low, with no differences between bortezomib‐based and non‐bortezomib‐based arms. Higher rates of oedema (mostly grade 1/2) were seen in bortezomib‐based versus non‐bortezomib‐based arms in one study and a pooled transplant study analysis. Logistic regression analyses of comparative studies showed no impact on cardiac risk with bortezomib‐based versus non‐bortezomib‐based treatment. Bortezomib‐based treatment was associated with low incidences of cardiac events.