Reardon Michael J, Walkes Jon-Cecil, Benjamin Robert
Methodist DeBakey Heart Center, Houston, TX 77030, USA.
Nat Clin Pract Cardiovasc Med. 2006 Oct;3(10):548-53. doi: 10.1038/ncpcardio0653.
Benign cardiac tumors are resected with a high degree of success with modern cardiac surgical techniques. Malignant cardiac tumors, however, continue to pose a therapeutic challenge to cardiac surgeons and oncologists because of the technical difficulty involved in extensive cardiac resections and the aggressive biological nature of the tumors. The majority of malignant cardiac tumors are sarcomas and can be categorized as right heart sarcoma, left heart sarcoma or pulmonary artery sarcoma. Right heart sarcomas are generally angiosarcomas, which infiltrate widely and metastasize early. A combination of chemotherapy and surgical resection is the preferred therapy. Left heart sarcomas, although large, are often less infiltrative and metastasize later than right heart sarcomas, but a similar approach to treatment is usually employed. Surgical resection is more-frequently necessary for left heart sarcomas because of intracardiac blood flow obstruction and congestive heart failure, although the anatomic position and relation of these tumors to cardiac structures can complicate surgery. We have developed and employed the technique of cardiac autotransplantation, which involves cardiac excision, ex vivo tumor resection with cardiac reconstruction, and cardiac reimplantation, to lessen these technical difficulties. Pulmonary artery sarcomas can be treated by radiotherapy, as well as by the other therapies, because the myocardium can be avoided by the radiation fields. Surgical resection of this sarcoma type often requires pneumonectomy and can require pulmonary root replacement.
采用现代心脏外科技术，良性心脏肿瘤的切除成功率很高。然而，恶性心脏肿瘤由于广泛心脏切除所涉及的技术难度以及肿瘤的侵袭性生物学特性，仍然给心脏外科医生和肿瘤学家带来治疗挑战。大多数恶性心脏肿瘤是肉瘤，可分为右心肉瘤、左心肉瘤或肺动脉肉瘤。右心肉瘤通常是血管肉瘤，广泛浸润且早期转移。化疗和手术切除相结合是首选治疗方法。左心肉瘤虽然体积大，但通常浸润性较小，转移时间比右心肉瘤晚，但通常采用类似的治疗方法。由于心内血流阻塞和充血性心力衰竭，左心肉瘤更常需要手术切除，尽管这些肿瘤的解剖位置及其与心脏结构的关系会使手术复杂化。我们已经开发并采用了心脏自体移植技术，该技术包括心脏切除、体外肿瘤切除并进行心脏重建以及心脏再植入，以减轻这些技术难题。肺动脉肉瘤可以通过放疗以及其他治疗方法进行治疗，因为放射野可以避开心肌。这种肉瘤类型的手术切除通常需要全肺切除术，并且可能需要进行肺动脉根部置换。
