心房粘液瘤手术的体外循环管理

目的　探讨心房粘液瘤手术的体外循环管理。方法　对 2 2例经术后病理学确诊为心房粘液瘤手术的体外循环管理方法进行回顾性分析。结果　 2 2例患者经手术治疗手术过程顺利 ,术后恢复良好 ,无手术死亡。结论　心房粘液瘤手术应注意 :1对术前心力衰竭严重、肝肿大、下肢水肿的病例宜选用血浆和白蛋白预充 ,转流中注意利尿 ,若条件许可可选用超滤器 ;2加强激活全血凝固时间 (ACT)的监测 ,防止抗凝意外 ;3粘液瘤瘤体易脱落引起栓塞 ,建议动脉端常规使用动脉滤器     

心房粘液瘤的外科治疗

１９９２年４月至１９９８年１２月,我院共手术治疗心房粘液瘤１３例,现将外科治疗体会报告如下。１临床资料１．１一般资料　本组１３例中,男６例,女７例;年龄１８～６７岁,平均４５岁。临床表现;活动后心悸、气短７例,胸闷、双下肢浮肿伴长期低热２例,晕厥１例。查体心尖部闻及舒张期杂音７例、双期杂音３例;三尖瓣区闻及收缩期杂音１例。杂音随体位变化１例,无杂音１例。肝脏肿大、下肢浮肿１例,贫血１例。术前心功能（ＮＹＨＡ分级） Ⅱ级７例,Ⅲ级４例,Ⅳ级１例。ＵＣＧ检查示心房内异常回声光团随心脏舒缩移动,左房粘…     

心房粘液瘤31例临床分析

回顾性分析经超声心动图诊断的心房粘液瘤３１例。２２例手术治疗并经病理确诊．其中２１例符合超声心动图诊断，另１例为心脏多发恶性肿瘤。本病临床表现多样化，以心慌气急为主２６例（８３．８％），其次晕厥、随体位变化的心脏杂音。病情发展大多迅速。本文提示超声心动图检查是诊断心房粘液瘤的重要手段，一经诊断，及时手术者预后良好。     

心房粘液瘤的诊断与外科治疗

心房粘液瘤的诊断与外科治疗济宁市第一人民医院（２７２１１１）冯先富刘风娥张庆河刘炳学杨业云心房粘液瘤属低度恶性心脏原发肿瘤，约占心脏原发肿瘤的５０％。我院于１９８５年９月至１９９６年６月收治心房粘液瘤患者２６例，均经手术治愈，随访４个月至１１年，效果...     

超声对心房粘液瘤的诊断价值

本文报告9例经手术和病理证实的心房粘液瘤的超声表现，旨在探讨超声对心房粘液瘤的诊断价值。     

心房粘液瘤的不同临床表现：附10例临床分析

心房粘液瘤占心脏肿瘤的30～50%,其诊断依据于心血管造影和心脏超声检查。由于本病的临床表现不同,故常易误诊。我们近来遇到一例以大咯血为临床表现的左心房     

右心房粘液瘤致肺动脉栓塞1例

1病历报告 患者,男,57岁.因突发晕厥,胸闷、胸痛、咯血、呼吸困难1d于2004年3月10日入院.患者于入院前1d突发晕厥,右胸痛、胸闷、咳痰带血、呼吸困难,发作性晕厥3次,持续约1～2min不等,可自行缓解,元抽搐.查体:T 37℃,P 103次/min,R 30次/min,BP 90/70mmHg(1mmHg=0.133kPa),面色发绀,颈静脉怒张,双肺底细小水泡音,右下肺呼吸音较左肺低.HR 103次/min,心律不齐,心音低钝,胸骨左缘3～4肋间闻及3/6收缩期杂音.     

Massive right atrial myxoma

Right atrial myxomas are uncommon and are often detected incidentally in asymptomatic individuals. We describe a case of a massive right atrial myxoma that was suspected following an abnormal right heart border on a chest X-ray and an abnormal 12 lead electrocardiogram.     

Right atrial myxoma mistaken for recurrent pulmonary thromboembolism

A 69 year old man was admitted for investigation of right sided pleuritic chest pain and dyspnoea, both of which began suddenly four days before admission. Acute pulmonary embolism was diagnosed. Six months after discharge while on warfarin he died. Necropsy found a 50 mm diameter myxoid tumour arising on the right atrial side of the interatrial septum. This lesion may have been discovered earlier by echocardiography although there were no clear indications for this investigation. Presentation was that of recurrent pulmonary embolism with no obvious source or cause of thrombosis. Patients who are thought to have idiopathic pulmonary embolism should undergo early echocardiography to exclude the rare but treatable diseases of the right heart that may be responsible

Keywords: atrial myxoma     

Massive right atrial myxoma presenting with syncope

A 65-year-old man presented to the emergency room following an episode of syncope. His vital signs and physical examination were unremarkable. A chest X-ray and an ECG were also normal. He was admitted to the hospital for further work-up. A computed tomography scan of his brain did not reveal any evidence of stroke, hemorrhage, or mass effect. A transesophageal echocardiogram, however, revealed tricuspid regurgitation and a right atrial mass with finger-like projections, which appeared to originate from the tricuspid valve. Left heart catheterization was performed, showing a 99% proximal right coronary artery stenosis. The patient was scheduled to undergo atrial mass resection, tricuspid valve annuloplasty, and coronary bypass. During the procedure, a large myxoma was found to be adherent to the right side of the atrial septum, adjacent to the fossa ovalis. The mass was friable and was attached to the endocardium by a pedicle. Following resection of the atrial mass and tricuspid valve annuloplasty, a single saphenous vein graft bypass to the right coronary artery was performed. The patient's postoperative course was unremarkable and he was discharged home on postoperative day 6.     

Delay in diagnosis of right atrial myxoma

Clinical, echocardiographic, and nuclear angiographic findings in a 51-year-old woman who presented with a history of dyspnea are discussed. Initial echocardiography revealed no abnormality. However, a subsequent radionuclide angiogram revealed a filling defect on the right side of the heart. This represented a right atrial myxoma. Radionuclide angiography can provide a useful noninvasive tool in the diagnosis of intracardiac tumors when echocardiography has not been helpful.     

全胸腔镜下左心房黏液瘤切除15例

目的 总结15 例全胸腔镜左房黏液瘤切除术的初步经验,探讨全胸腔镜下心内手术的安全性和适应证.方法 2012年1 月至2013 年10 月,收治15例左房黏液瘤患者,女性10 例,男性5 例,其中5例合并二尖瓣关闭不全行二尖瓣成型术.全身麻醉下,双腔气管插管,采用股动静脉插管、右侧颈内静脉引流进行体外循环.右侧胸壁3个1～2 cm切口,在全胸腔镜下行左房黏液瘤切除术.结果 15 例手术均顺利进行.1例因瘤蒂位于左房底,瘤体大暴露困难,正中切口开胸手术,其余均全腔镜下完成手术.体外循环（40±15）min,升主动脉阻断（30±12）min,术后呼吸机辅助（4.5±1.4）h,术后住院（5.6±1.3）d.无大出血、术后再次开胸止血、脑栓塞等并发症.术后病理检查,1例为左房肉瘤,其余均为左房黏液瘤.结论 全胸腔镜左房黏液瘤切除技术可行、安全,既减少了常规正中开胸的手术创伤,又没有过度延长体外循环时间造成的进一步全身器官损害,有利于患者的术后早日康复,手术切口小、美观.     

Left atrial mass: thrombus mimicking myxoma

A 31-year-old woman underwent elective transthoracic echocardiography for paroxysmal atrial fibrillation, which showed a large left atrial mass. A two-dimensional echocardiogram showed a large left atrium mass. Subsequent transesophageal echocardiography showed a 3 cm x 3 cm circular mass with smooth contours. The differential diagnosis included myxoma versus thrombus, but because of morphology and mobility of the mass, it was difficult to differentiate one from the other. The patient had been on chronic coumadin therapy for paroxysmal atrial fibrillation. An operation was performed and the intracardiac mass resected. On pathologic examination the mass was diagnosed as an organized thrombus. A brief review of the literature has been presented to discuss the differential diagnosis of the mass in the left atrium.     

Left atrial myxoma associated with rheumatic mitral stenosis

The rare occurrence of mitral stenosis and coexistent left atrial myxoma is reported. The patient had a 25-year history of rheumatic heart disease and was referred for evaluation of progressive mitral stenosis without clinical suspicion of left atrial myxoma. The tumor was discovered by routine echocardiography in the course of evaluation of mitral stenosis. However, prior to surgery the patient experienced an episode of embolization of the tumor without major clinical sequelae. The utility of echocardiography in this case and in patients with mitral stenosis is discussed as well as the patient's spontaneous "cure."     

Fluctuating symptomatic cryofibrinogenaemia in a patient with left atrial myxoma

Summary. We report a case of left atrial myxoma associated with a fluctuating level of cryofibrinogen. Her initial symptoms and signs were consistent with primary cryofibrinogenaemia, but a repeat episode occurred without the cryofibrinogen being detectable. A more typically embolic cerebro-vascular accident (CVA) occurred, with the subsequent discovery of the patient's myxoma. The cryofibrinogen was again present but it disappeared with resection of the myxoma. We propose that the degree of activation of the coagulation system around the myxoma fluctuated, causing variable conversion of fibrinogen to fibrin, so that at times partially cross-linked fibrin(ogen) resulted in cryofibrinogen, but at other times frank emboli from more complete clotting occurred.     

Concomitant occurrence of a left atrial myxoma and an adenocarcinoma of the lung

A 72-year-old previously healthy woman was found to have both a left atrial myxoma and a left lung mass during the evaluation for two cerebrovascular events. Resection of the atrial myxoma and a biopsy of the left lung mass were performed. Six weeks later she underwent a left upper lobectomy for adenocarcinoma of the lung. This case illustrates the concomitant occurrence of a left atrial myxoma and a primary lung cancer in a patient who underwent a successful staged treatment for both diseases.     

Survival of a patient with an infected right atrial myxoma following surgery

We describe an infected right atrial myxoma in a previouslyhealthy 16-year-old schoolboy. He presented with high temperaturesand rigors due to staph aureus septicaemia. The illness respondedslowly to antibiotics and he became afebrile. Whilst awaitingsurgery the temperature recurred. He underwent removal of themyxoma and is the only reported patient to have survived infectionof a right atrial myxoma.