左心房粘液瘤24例的外科治疗

自1979年9月至1987年3月手术治疗左房粘液瘤24例,死亡2例。均经超声心动图检查确诊。心脏粘液瘤虽属良性肿瘤,但也可恶性变。肿瘤碎块脱落,引起肺循环或体循环栓塞或猝死,一旦确诊,就应尽早手术。作者认为,经右房切口切除左房粘液瘤较为方便并利于探查右房,排除粘液瘤穿越间隔。24例全部切除卵圆窝处房间隔,18例直接缝合,6例用心包补片修补房间隔。平均随访27个月,效果满意,无复发。     

经左房切口行左房粘液瘤切除

左房粘液瘤一旦诊断明确应尽快手术。关于心脏切口的选择。多数在主张经右房及房间隔切口。本文报告左房切口行左房粘液瘤切除术２１例，并就左房切口的优点，左房粘液瘤与二尖瓣的关系及术后并发症进行讨论。     

经左房切口行左房粘液瘤切除(附21例报告)

左房粘液瘤一旦诊断明确应尽快手术。关于心脏切口的选择，多数人主张经右房及房间隔切口。本文报告经左房切口行左房粘液瘤切除术２１例，并就左房切口的优点、左房粘液瘤与二尖瓣的关系及术后并发症进行讨论     

幼儿左房多发性粘液瘤1例

患儿 ,男 ,3岁。因活动后气短半年。病中有晕厥史 ,彩超检查诊断为左房粘液瘤入院。经术前准备在全麻低温体外循环下进行手术 ,术中见左房卵圆窝处有一 2 0cm× 2 0cm× 2 5cm淡黄色胶冻样肿物 ,瘤蒂长约 0 7cm ;左房壁亦有 2枚花生米、黄豆大小之赘生物 ,将肿瘤自根部连同部分心肌组织完整摘除 ,反复冲洗左心腔 ,缝合左房壁和房间隔裂口。术后患儿临床症状、体征消失。病理诊断 :左房多发性粘液瘤。心脏粘液瘤多发生于 30～ 6 0岁的成年人 ,左右房或房室粘液瘤文献曾有报道 ,幼儿左房多发性粘液瘤较为罕见。 0rr认为粘液瘤增生部分为心…     

超声心动图诊断左房粘液瘤5例报告

粘液瘤是心内膜下残留的胚胎性间叶细胞呈良性肿瘤性增生所致的心脏肿瘤。可见于心房或心室中,一般以左房粘液瘤为最多见。左房粘液瘤常为单个、带蒂,起源于房间隔的卵圆窝附近,临床表现酷似二尖瓣狭窄,往往易造成误诊。近年来虽可用心血管造影确诊,但操作繁琐,对病者有痛苦及危险,故不能广泛应用,致使病人延误诊断及治疗。由于超声心动图诊断的进展,它能明确地显示心脏内肿瘤的异常团块回声,为临床及时、准确诊断本病提供重要依据。现将5例先经超声心动图探查,后经手术及病理诊断证实的左房粘液     

心房粘液瘤的临床表现及超声心动图诊断

心房粘液瘤系心脏原发性肿瘤,据统计占所有心脏肿瘤的50％。左房粘液瘤发病率较高,约占心脏粘液瘤的75％,少数为右房粘液瘤。本病多见于女性,女与男之比约为3:1。心房粘液瘤多有蒂,附着于房间隔的卵园窝或近旁,少数基底延     

左房粘液瘤五例报告

本文报告五例左房粘液瘤。临床表现类似二尖瓣狭窄症,但具有左房粘液瘤的特征,均经超声心动图确诊。五例都经手术治疗,其中两例为急症手术。一例为心源性休克伴急性肺水肿,另一例为急性体动脉栓塞。手术采用右心房切口经房间隔进路摘除肿瘤。近期效果良好。追踪1～5年无复发。     

心腔内粘液瘤的诊治（附18例报告）

心腔粘液瘤１８例，其中左心房粘液瘤１６例，右心房及左心室粘液瘤各１例。所有病例均经超声心动图（ＵＣＧ）诊断，全麻体外循环下胸骨正中切口入路，经房间沟、右房、左房或房间隔切开完成手术。为防止肿瘤组织脱落造成周围血管栓塞，术中除了轻柔的操作，并采用负压抽吸法将瘤体较完整地吸入到心脏切口外针筒内，然后从基底部切除粘液瘤。１８例患者无１例发生手术后栓塞。     

左房黏液瘤手术切除21例

目的评价体外循环下手术切除左房黏液瘤的方法和临床疗效.方法回顾性分析21例体外循环下经右房-房间隔切口行左房黏液瘤切除术患者,其中4例在不阻断升主动脉、心脏跳动下完成手术,随访:1月～9年.结果体外循环转机24～62 min,无围术期死亡及肿瘤栓塞,远期复发1例,复发率为4.76%.术后3月心功能评价(NYHA分级):I级18例,Ⅱ级3例.结论体外循环下经右房-房间隔切口切除左房粘液瘤方法简单、安全、疗效好.可以考虑不阻断升主动脉在心脏跳动下切除左房粘液瘤.     

肿瘤学

980710老年人左房粘液瘤的外科治疗/杨光爆…//中华老年医学杂志一1997,16(6)一330 7例年龄65一72岁,均经彩色多普勒超声心动图检查确诊为左房粘液瘤。5例首先接受强心、利尿及扩血管治疗;1例并存冠心病者同时给硝酸甘油、倍他乐克等扩冠治疗;并存慢性支气管炎肺气肿、急性肺部感染者同时给抗感染治疗。6例分别于入院后7一n天手术,n例有晕厥史者于等待手术期间出现急性左心衰,于人院后第3天急诊手术。7例均在全麻中度低温体外循环下经右房及房间隔径路、距肿瘤蒂基0.5一l.ocm同心圆切除房间隔,完整切除肿瘤,瘤体重56一2939。升主动脉血流阻…     

Floating left atrial mass in a patient with mitral stenosis

Mobile masses within the left atrial cavity are commonly caused by organized thrombi or left atrial myxoma. The use of transesophageal echocardiography has provided means for differentiation between the 2 conditions. We report a case of a left atrial mass in a female patient who presented with mitral stenosis and atrial fibrillation, and was diagnosed by transthoracic echocardiography (TTE). The mass appeared freely mobile but did not prolapse between the mitral leaflets due to the tightly stenosed valve orifice. In the presence of mitral stenosis, atrial fibrillation and dilated left atrium, the appearance of the mass was in keeping with mobile thrombus. Consequently, the patient was referred for surgical treatment and the mass removed through left atriotomy. Microscopic examination revealed a highly organized thrombus. We conclude that TTE is still a reliable tool in the diagnosis of large mobile atrial thrombi; TEE is needed when differentiation from atrial myxoma is difficult.     

A case of mimicking left atrial myxoma demanding emergency surgery

Despite the considerable mortality and morbidity in metastasis cardiac mass, antemortem diagnosis is unusual. Here we report a case of a left atrial mass echocardiographically mimicking myxoma, in a patient with lung carcinoma. The mass was pathologically confirmed to be metastatic carcinoma, which had entered the left pulmonary vein, illustrating the potential for unusual routes of tumor spread into tissue diagnosis in such cases atrium via direct invasion of left superior the heart and the importance of obtaining a     

Cerebellar embolization in patients with heart murmur

A 76-year-old female present to the emergency department with dysarthria, dizziness, dyspnea. The patient had hypertension and atrial fibrillation. Brain MRI revealed right cerebellar infarction. Transthoracic echocardiography showed a large round mass in the left atrium. Transesophageal echocardiography showed large complex echogenic round mass lesion attached on left atrial side of interatrial septum. Coronary angiogram revealed round movable mass lesion in left atrium with feeding arteries originated from right coronary artery. She underwent removal of mass and Maze operation, and pathologic finding was compatible with myxoma.     

An interesting case of left atrial myxoma

Myxoma is the most common type of primary tumours of the heart in adults. Majority of these myxomas are found in the left atrium, followed by the right atrium and ventricles. We describe herein a patient who had a left atrial myxoma with interesting investigational results.     

An unusual presentation of atrial myxoma

Myxomas are uncommon primary cardiac tumours that usually affect the left atrium. We herein report the case of a patient who presented with right heart failure and proteinuria, leading to the diagnosis of atrial myxoma. Surgical resection resulted in resolution of the patient’s symptoms.     

左房黏液瘤致脑梗死及脑转移1例并文献复习

目的 对1例左房黏液瘤致脑梗死及脑转移患者的临床表现、影像学特征、治疗方法进行分析,以提高临床医生对该疾病的诊疗能力。方法 回顾1例诊断为左房黏液瘤脑转移患者的临床资料并进行分析,结合相关文献对该疾病进行总结。结果 患者为69岁、男性,入院前6个月因急性脑梗死检查发现左心房占位,术后病理显示左房黏液瘤;入院前3个月检查发现颅内多发占位;入院完善相关检查,行手术治疗,术后病理显示：心房黏液瘤转移。结论 心房黏液瘤可引起多发急性脑梗死及脑转移,对于多发急性脑梗死患者有必要进行心脏超声检查,脑转移通常在诊断为心脏黏液瘤的同时或几个月后发现,因此,心房黏液瘤患者需要长期随访。     

心内占位病变患者的诊断和外科治疗（附47例分析）

目的：总结心内占位病变诊断和外科治疗经验。方法：1995年6月至2011年4月我院收治的47例心内占位病变患者的临床资料,其中良性肿瘤43例（91．4％）,均为粘液瘤,分布于左房41例,右房1例,右室1例;恶性肿瘤2例,分别为右室横纹肌肉瘤和左房肺动脉内膜肉瘤;左室附壁血栓1例;左心耳内翻1例。所有患者均在中度低温体外循环下手术,同期行二尖瓣成形术2例,三尖瓣成形术1例。结果：1例粘液瘤术后2年复发,分布于左房及右房,再次手术切除。2例恶性肿瘤均于术后6个月内死亡。其余心内占位病变恢复良好。结论：典型粘液瘤经超声心动图即可确诊,非典型粘液瘤及其它非典型部位的心内占位病变需借助CT、MRI及PET进一步明确诊断。心脏占位病变一经诊断应尽快手术,即使发生脑梗塞也非手术禁忌,良性肿瘤预后较好．恶性肿瘤预后较差。     

心房粘液瘤21例分析

目的探讨心房粘液瘤的诊断和外科治疗。方法21例心房粘液瘤均经B超确诊,在全身麻醉、中度低体温体外循环下进行手术切除。结果体外循环时间38～98min,平均45±12.4min,主动脉阻断时间29～78min,平均34±11.3min,实行左房粘液瘤切除15例,右房粘液瘤切除6例,无围手术期死亡,均痊愈出院。术后随访2年,1例复发,二次手术治愈。结论心房粘液瘤确诊后应尽早手术治疗,术中应加强心肌保护,术中完整切除瘤体,避免肿瘤复发。     

心腔粘液瘤的外科治疗(附7例报告)

报告了手术治疗心腔粘液瘤7例,其中发生于左心房5例,右心房1例、左心室1例。6例完整切除,1例瘤体术中破碎并发脑栓塞。作者认为本病确诊后应积极手术并重点讨沦了各心腔粘液瘤手术切口的选择及预防并发症的注意事项。