心脏原发肿瘤的诊断和治疗(摘要)

１　临床资料　　１９８０～１９９９年４月我院共收治心脏原发肿瘤病人１５９例,男５９例,女１００例,年龄１０～７０岁。其中良性粘液瘤１５２例,恶性粘液瘤３例,恶性间皮瘤２例,恶性血管内皮瘤１例,横纹肌肉瘤１例。起病至就诊时间３天～１０年,首诊偏瘫者７例,首诊以右下肢动脉栓塞１例。全组中有１５６例心腔内肿瘤术前均经二维超声心动图或彩色超声心动图检查,发现心腔内团状回声,３例室壁肿瘤超声心动图显示心室外侧包块。１５９例病人除１例左心房粘液瘤（ＬＡＭ）,１例右心室粘液瘤在术前等待手术中突然死亡外,对１５…     

51例心脏原发性肿瘤的超声评价

对 51例心脏原发性肿瘤进行回顾性分析 ,其中 4 2例为左房粘液瘤 (82 .4 % ) ,6例为右房粘液瘤(11.9% ) ,1例为左室横纹肌瘤 (1.96 % ) ,2例为右室纤维肉瘤 (3.92 % ) ,全部病例均做心脏超声检查 ,符合率10 0 % ,被认为是确诊本病的首选及最佳方法。本文同时对心房粘液瘤瘤蒂长短、活动度大小、基底部宽窄与手术时间及方法选择的关系 ,各种肿瘤最佳切面观察进行了讨论。     

心脏粘液瘤的神经系统表现

心脏肿瘤的发病率约占尸检的0.05％,其中50％为粘液瘤,左房粘液瘤又占75％。心房粘液瘤在组织学上属良性,如能及时诊断,本病可成功地进行手术治愈,否则可致残废或死亡。因其临床表现变幻莫测,常无心脏的直接表现,因而对本病的早期认识是非常重要的。作者报告3例,例1有下肢血管栓塞、发作性脑缺血,实验室异常提示为胶原性血管病,一年后因周围血管虚脱而死亡。尸检发现左心房粘液瘤,心包和胃积血、脑多发性出血性梗死,镜检发现心肌动脉等     

心脏粘液瘤的临床诊断及手术治疗

目的：总结我院60例心脏粘液瘤患的超声心动图特征及手术治疗的资料。方法：利用超声心动图观察粘液瘤的数目、位置、大小、形状、瘤蒂情况，表面特征，瓣膜梗阻，返流，心脏继发改变，并与手术发现进行对比。结果：左房粘液瘤55例，其中多发瘤4例；右房粘液瘤5例，均行手术切除，术后效果良好，无复发。结论：超声心动图对本病有很高的诊断价值，手术切除是其治疗的有效方法。     

心脏粘液瘤41例临床病理分析

报告心脏粘液瘤41例,其中粘液肉瘤1例。并讨论粘液瘤部位、本质,组织发生和生物学特性。     

右房粘液瘤二例

右房粘液瘤二例浙江医科大学附属第二医院心胸外科何忠良，张昌铭我们于１９８１年到１９９３年间，手术治疗心脏粘液瘤共３１例，其中２例为右房粘液瘤，现报告如下：１临床资料例１女性，５４岁。因胸闷、心悸１个月伴经常晕厥入院。超声心动图示右房内有４×５×５ｃｍ...     

单纯右房粘液瘤四例报告

单纯右房粘液瘤四例报告北京市安贞医院心外科陈宝田，郭金堂，顾承雄北京市安贞医院心外科１９８４年至１９９２年共收治心脏粘液瘤４５例，其中右房粘液瘤４例，双房粘液瘤３例，均在体外循环下手术治疗。现将我们的体会报告如下：１临床资料本组男１例，女３例，年龄最...     

心脏粘液瘤的诊断与外科治疗（附71例报告）

共收治71例心脏粘液瘤患者。左房粘液瘤62例,其中多发瘤3例、合并室间隔缺损2例、二尖瓣关闭不全1例,右房粘液瘤9例、均由超声心动图确诊,并在全麻体外循环下手术摘除粘液瘤,同期行二尖瓣成形和二尖瓣替换术各1例,室缺修补术2例。术后2例死亡（2．8％）。随访9个月－16年,2例复发（2．8％）。认为超声心动图对心脏粘液瘤的诊断具有特殊价值,心脏粘液瘤一经诊断应立即手术,彻底切除是预防复发 的关键。     

家族性心脏粘液瘤多次再发二例

家族性心脏粘液瘤多次再发二例河北省唐山市工人医院胸心外科余永昌，杜绍琴，袁茂昆姬尚义等［胸心血管外科杂志，１９８８，４：８７．］曾报告母女发病的家族性心脏粘液瘤２例。数年后该２例患者因粘液瘤复发、再发在我院分别行第２次、第３次手术治疗。为使读者便于了...     

左房粘液瘤三例

左房粘液瘤三例内蒙古自治区妇幼保健院心外科阿尔泰，巴特尔，商乃集，王震玺自１９８８年至１９９４年间，我院收治心房粘液瘤３例，均手术治愈。现报道如下：１临床资料３例患者中男性１例，女性２例，年龄分别为３９岁、５５岁、３３岁。均有活动后心悸、胸闷。查体：...     

Left ventricular myxoma: Missed vs metastatic

Left ventricular myxomas account for 2.5% of all cardiac myxoma cases. There are very few case reports on left ventricular myxoma (LVM) presented after complete surgical resection of left atrial myxoma. Here we report a case of a 58-year-old male presented to the hospital for transient limb weakness, numbness and dysarthria. Magnetic resonance image of the brain revealed multiple thromboembolic cerebrovascular accidents. Transthoracic echocardiogram (TTE) revealed a left atrial myxoma. It was resected completely with good surgical margins. After one and half year he started having dizziness, and transient right sided weakness. Computer tomography scan of the head revealed a progression of thromboembolic disease. TTE revealed a LVM that was confirmed by transesophageal echocardiogram. It was resected with good surgical margins 3 wk after recurrent cerebrovascular accident.     

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.     

Massive right atrial myxoma: an unusual presentation in an elderly patient

Primary heart tumors are rare with an estimated incidence ranging 0.0017-0.19%. Myxoma is the most prevalent primary heart tumor. The right atrium is an unusual location, occurring only in the 15-20% of myxoma cases. We describe the case of a massive right atrial myxoma causing right ventricular inflow and tricuspid valve obstruction. The tumor was detected by echocardiography and confirmed by abdomen-thoracic tomography. It was resected along with a section of tricuspid septal leaflet, followed by primary repair. In 2-year follow-up the patient is asymptomatic.     

Mitral and tricuspid lesions associated with polypoid atrial tumors, including myxoma

The related atrioventricular valves in 11 instances of polypoid atrial tumors were examined grossly and histologically. Nine of the tumors involved the left atrium and, of these, seven were myxomas. The two right atrial tumors were myxomas.

Histologically evident lesions of the mitral valve were present in seven of the nine left atrial tumors. The most common change consisted of fibrous thickening of the endocardium in the angle between the left atrium and posterior mitral leaflet and fibrous thickening of the atrial surfaces of the leaflet. Less common changes were a fibrous thickening of the chordae and of the left ventricular mural endocardium in relation to chordae inserting into the posterior leaflet. The changes described were also evident at gross examination in two of the nine cases with left atrial tumors.

In the two cases of right atrial myxoma, both showed fibrous thickening of the atrial surfaces of the tricuspid leaflets; one also exhibited fibrous thickening of the right ventricular endocardium beneath the septal leaflet of the tricuspid valve.

The lesions described are considered responses to the effects of friction by the tumor upon the surfaces involved. It is significant that grossly evident lesions may evolve from this rubbing action.     

Selective coronary angiography in intracardiac tumors

Cardiac catheterization and selective coronary angiography were performed in ten patients with intra-cardiac tumors [left atrial myxoma (7), right atrial myxoma (1), angiosarcoma of right heart (1), and right ventricular tumor (1)]. The patient with angiosarcoma had characteristic hemodynamics suggesting cardiac compression. The coronary arteriographic finding included: neovascularization (8); filling defect due to emboli (1); and displacement of coronary artery (1). Tumor neovascularization from branches of the left circumflex or right coronary artery was invariably observed in patients with myxoma. We conclude that invasive studies are safe, provide additional information of academic interest, and occasionally aid in the diagnosis.     

64例心脏粘液瘤外科治疗分析

本文报道64例心脏粘液瘤的手术治疗。术中发现粘液瘤在左心房56例,右心房7例;左心室1例。左心房粘液瘤中有2例为恶性粘液瘤。64例肿瘤均在体外循环直视下切除。术前确诊依靠超声心动图和多普勒检查,手术后死亡3例,死亡率为4.7%。     

Prolapsing right atrial myxoma: clinical and heamodynamic considerations.

A 22-year-old woman with a right atrial myxoma prolapsing to the right ventricle is described. The haemodynamic findings were similar to those of cases of prolapsing myxoma of the left atrium; a notching on the ascending limb of the right ventricular pressure curve, and an initial negative, irregular deflection on the pulmonary artery pressure curve with a pronounced rise in the mean right atrial pressure (18 mmHg) were found. On deep inspiration there was a significant deepening of the y descent from 12 mmHg to 2 mmHg, indicating a changing, dynamic obstruction of the right ventricle inflow tract. These haemodynamic features can be helpful in the diagnosis of prolapsing right atrial myxoma.     

Familial recurring cardiac myxoma

A 34-year-old woman presented with her fourth occurrence of an atrial myxoma and a right lower lung field mass. Her surgical history was extensive. In addition to resection of three previous atrial myxomas, she had undergone resection of her adrenal glands as a teenager because of Cushing's syndrome, and a hysterectomy at age 26 revealed a myxoid leiomyoma. Family history was remarkable as a maternal uncle and daughter died from embolic complications of left atrial myxomas and her sister previously had a left atrial myxoma resected. The patient underwent uncomplicated removal of the myxoma, and resection of the lung mass revealed a granuloma. A review of typical and atypical aspects of cardiac myxomas is provided including a rare and recently described syndrome of familial cardiac myxoma associated with Cushing's syndrome, spotty skin pigmentation and other myxoid tumors.     

Primary atrial heart tumors--a review of 21 cases

Between 1978 and 1986, atrial heart tumors were found in 21 of our patients, all of them subsequently underwent surgery. Pathological-histological examination in 20 patients confirmed the diagnosis of a myxoma; the one remaining case was a female patient with primary cardiogenic osteosarcoma. Of the 20 patients, 15 (75%) were females; in four female patients (20%) the tumor was localized in the right atrium. The main symptoms and findings were elevated erythrocyte sedimentation rates (80%), stress-induced dyspnea or paroxysmal dyspnea (71% resp.), and diastolic mitral or tricuspid murmurs (62%). The patient with osteosarcoma died of cachexia on the basis of generalized diffuse metastases. One female patient with a preoperative history of severe left ventricular impairment on the basis of dilative cardiomyopathy died 5 weeks after surgery. Relapse of atrial myxoma has not yet occurred during follow-up since 1978.     

A Japanese case of familial cardiac myxoma associated with a mutation of the PRKAR1alpha gene

Familial cardiac myxoma is inherited as an autosomal dominant syndrome. Here, we report a Japanese case of familial cardiac myxoma identified as a genetic abnormality. The mother experienced multiple recurrence of tumors in the left atrium and left ventricle 40 months after surgical resection of a left atrial myxoma. All recurrent tumors were successfully resected. Her daughter also had a solitary myxoma in the left atrium, but she had no recurrence after the operation. Both patients had lentigines in their face but no endocrine abnormality. Molecular genetic analysis demonstrated involvement of a mutation in the PRKAR1alpha gene.