Schütz W H, Römpp A, Neglein J
Institut für Anästhesiologie, Universität Erlangen-Nürnberg.
Dtsch Med Wochenschr. 1992 Sep 25;117(39):1469-73. doi: 10.1055/s-2008-1062466.
A 46-year-old woman known to have an asymptomatic left atrial tumour suddenly developed dyspnoea, tachycardia (up to 140 beats/min) and a fall in systolic blood pressure to 80 mm Hg, 12 days after an extensive radical operation for metastatic ovarian carcinoma. Echocardiography demonstrated a large left atrial tumour which impaired left ventricular filling. A previously healthy 42-year-old man reported increasing exertional dyspnoea with retrosternal feeling of tightness. A 2/6 systolic murmur was audible over the cardiac apex, a 3/6 diastolic murmur heard maximally over the 2nd intercostal space, and there was a third heart sound. The chest X-ray film demonstrated pulmonary venous congestion and there was an enlarged P-wave in the ECG suggesting left-atrial enlargement. Echocardiography revealed a myxoma-like tumour in the left atrium. A thoracotomy was performed in both patients. Using intra-operative transoesophageal echocardiography, the attachment of the tumour (in both instances a myxoma), the course of the operation and, after tumour removal, normal valvar and cardiac function were demonstrated. In case 2, the echocardiographic findings justified an atypical approach via the right atrium. In both patients removal of the tumour and the postoperative course were without complication.
一名46岁女性，已知患有无症状的左心房肿瘤，在接受转移性卵巢癌广泛根治性手术后12天，突然出现呼吸困难、心动过速（高达140次/分钟），收缩压降至80毫米汞柱。超声心动图显示左心房有一个大肿瘤，影响左心室充盈。一名42岁以前健康的男性报告说，劳力性呼吸困难加重，伴有胸骨后紧迫感。在心尖部可闻及2/6级收缩期杂音，在第二肋间最响处可闻及3/6级舒张期杂音，并有第三心音。胸部X线片显示肺静脉淤血，心电图显示P波增大，提示左心房扩大。超声心动图显示左心房有一个黏液瘤样肿瘤。两名患者均接受了开胸手术。术中使用经食管超声心动图，显示了肿瘤（两例均为黏液瘤）的附着情况、手术过程，以及肿瘤切除后瓣膜和心脏功能正常。在病例2中，超声心动图检查结果证明经右心房的非典型入路是合理的。两名患者肿瘤切除及术后过程均无并发症。
