Olsun Adlan, Duzyol Cagri, Gur Ali Kemal, Kaplan Mehmet, Tosun Remzi
Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey.
Heart Surg Forum. 2007;10(3):E219-21. doi: 10.1532/HSF98.20061216.
A 32-year-old female patient presented with dyspnea and palpitation, and transthoracic echocardiography revealed the presence of pericardial effusion. Pericardiosynthesis was performed for drainage. Because of the rapid accumulation of effusion and the presence of a right atrial mass on follow-up echocardiography, a computed tomography scan was done that revealed a right atrial defect and the presence of advanced pericardial effusion. The patient was prepared for an emergency operation. The mass on the right atrial wall was approached via a midsternal incision with cardiopulmonary bypass. The tumor filled the right atrial cavity, compressed vital structures, extended to the right ventricle, and had local metastases. As the tumor did not appear to be curable with surgery, a palliative approach was adopted. The right atrial free wall and tissues causing cardiac obstruction were totally removed, the tumor itself was partially excised, and local metastases were sampled. The resulting right atrial wall defect was closed with a Dacron patch. The operation ended uneventfully, and the clinical status and vital and hemodynamic findings of the patient returned to normal. The pathological diagnosis based on the samples obtained during the operation was angiosarcoma. The patient had an uneventful postoperative period and was then referred to an oncology center for clinical recovery. No findings of local recurrence or metastases were observed during the postoperative follow-up. The patient completed her combination therapy and currently is free of any clinical problems at her 13th postoperative month. We believe that advancements in radiotherapy and chemotherapy regimes combined with surgery (radical, if possible) for the treatment of cardiac angiosarcomas may provide better survival and quality-of-life results.
一名32岁女性患者出现呼吸困难和心悸，经胸超声心动图显示存在心包积液。进行了心包开窗引流术。由于积液迅速积聚且随访超声心动图显示右心房有肿块，遂行计算机断层扫描，结果显示右心房缺损及大量心包积液。患者准备接受急诊手术。通过正中胸骨切口并在体外循环下处理右心房壁上的肿块。肿瘤充满右心房腔，压迫重要结构，延伸至右心室，并伴有局部转移。由于肿瘤似乎无法通过手术治愈，故采取姑息治疗方法。完全切除右心房游离壁及导致心脏梗阻的组织，部分切除肿瘤本身，并取局部转移灶组织进行活检。用涤纶补片封闭 resulting 右心房壁缺损。手术顺利结束，患者的临床状况、生命体征和血流动力学指标恢复正常。根据手术中获取的样本进行病理诊断为血管肉瘤。患者术后恢复顺利，随后被转至肿瘤中心进行临床康复。术后随访期间未观察到局部复发或转移迹象。患者完成了联合治疗，在术后第13个月时目前没有任何临床问题。我们认为，放疗和化疗方案的进展与手术（尽可能行根治性手术）相结合用于治疗心脏血管肉瘤可能会带来更好的生存和生活质量结果。 （注：“resulting”此处翻译可能不准确，原文可能有拼写错误，推测可能是“resultant”，但按要求未修改。）
