Khan Muhammad Aamir, Khan Asif Ali, Waseem Muhammad
Department of Cardiac Surgery, Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, Pakistan.
J Ayub Med Coll Abbottabad. 2008 Apr-Jun;20(2):76-9.
Cardiac myxomas are the most common benign intracardiac tumours. We studied the clinical presentation of cardiac myxomas and the morbidity, mortality and recurrence rate following surgery at our institution over a 6 year period.
This historical longitudinal study was performed at department of Cardiac Surgery, Armed forces Institute of Cardiology and National Institute of Heart Diseases Rawalpindi, Pakistan between January 2002 and March 2008 a total number of 8506 cardiac operations were performed. Of these 34 patients (19 males, 15 females) underwent complete excision of primary or recurrent intracardiac myxomas. Pre-operative diagnosis was established by echocardiography. All patients underwent operation soon after the diagnosis of a myxoma was made. Complete tumour excision followed by close inspection and copious saline irrigation of the cardiac chambers was done in each case. Of the 32 patients who survived the surgery, 29 patients were followed up at regular intervals for recurrence. The mean follow-up period was 34 months.
Cardiac myxomas constituted 0.40% of the total cardiac operations at our institution. They most commonly occurred in the fourth decade. The commonest location was the left atrium (LA) (79%) followed by the right atrium (RA) (14%). Only one patient had myxoma in the right ventricle (RV). Patients with LA myxoma simulated mitral stenosis clinically whereas patients with RA and RV myxomas presented with features of right heart failure. A smaller percentage presented with embolic and constitutional symptoms. There were two early deaths. One recurrence was noted at 27 months after surgery. No late deaths were observed in the study.
Cardiac myxomas form a very small percentage of the cardiac cases. A high index of suspicion is essential for diagnosis. Echocardiography is the ideal diagnostic tool as also for follow-up. Immediate surgical treatment is indicated in all patients. Cardiac myxomas can be excised with a low rate of mortality and morbidity.
心脏黏液瘤是最常见的心脏良性肿瘤。我们研究了心脏黏液瘤的临床表现以及我院6年间手术治疗后的发病率、死亡率和复发率。
这项历史性纵向研究于2002年1月至2008年3月在巴基斯坦拉瓦尔品第武装部队心脏病学研究所和国家心脏病研究所心脏外科进行，共进行了8506例心脏手术。其中34例患者（19例男性，15例女性）接受了原发性或复发性心脏黏液瘤的完整切除。术前诊断通过超声心动图确定。所有患者在诊断为黏液瘤后不久即接受手术。每例患者均进行了完整的肿瘤切除，随后对心腔进行仔细检查并用大量生理盐水冲洗。32例术后存活的患者中，29例接受了定期随访以观察复发情况。平均随访期为34个月。
心脏黏液瘤占我院心脏手术总数的0.40%。它们最常发生在第四个十年。最常见的部位是左心房（LA）（79%），其次是右心房（RA）（14%）。只有1例患者的黏液瘤位于右心室（RV）。左心房黏液瘤患者临床上表现为二尖瓣狭窄，而右心房和右心室黏液瘤患者表现为右心衰竭的特征。较小比例的患者表现为栓塞和全身症状。有2例早期死亡。术后27个月发现1例复发。研究中未观察到晚期死亡。
心脏黏液瘤在心脏病例中所占比例非常小。高度怀疑对于诊断至关重要。超声心动图是理想的诊断工具，也是随访的理想工具。所有患者均应立即进行手术治疗。心脏黏液瘤可以以较低的死亡率和发病率切除。
