Novitzky Dimitri, Guglin Maya, Sheffield Cedric
University of South Florida, Tampa, Florida 33606 , USA.
Heart Surg Forum. 2009 Oct;12(5):E279-84. doi: 10.1532/HSF98.20091027.
We describe the management of a patient who presented with symptoms of severe congestive heart failure. A 48-year-old man was initially seen in the emergency room, admitted to the hospital, and worked up with a transthoracic echocardiogram, a transesophageal echocardiogram, and a computer tomography scan of the chest. All cardiac valves were normal, as was the left ventricular ejection fraction. A mobile left atrial tumor measuring 6 x 4 x 5 cm was found attached to the left atrial dome, left atrial cuff, and left pulmonary veins. With each systolic atrial contraction, the mass prolapsed into the left ventricle across the mitral valve annulus, inducing a gradient of 19 mm Hg. The workup of the patient was negative for malignancy. The only feasible therapy for this patient was to excise the mass on cardiopulmonary bypass and cardioplegic arrest. At the time of surgery, the findings confirmed that the mass was attached broadly to the left atrial dome wall-epicardium, and the attachments were similar to those of the transesophageal echocardiographic findings. Atrial attachments extended from the base of the heart, along the atrioventricular groove, the left dome of the left atrium, the left atrial cuff, and the anterior aspect of both left pulmonary veins. The tumor could not be adequately excised, and reconstruction of the defect was not feasible with the heart in situ. We therefore decided to explant the heart and excise the tumor with a 0.5-cm margin of healthy tissue. The broad left atrial defect was reconstructed with bovine pericardium. The reconstruction encompassed the dome of the left atrium, the left atrial cuff, and the pulmonary veins. The heart was reimplanted back into the pericardial cavity. The superior vena cava with the retained sinus node was also anastomosed. The pathology diagnosis was a benign cavernous hemangioma. The sinus rhythm recovered following removal of the aortic cross-clamp and reperfusion of the heart. The patient had a rapid recovery and was discharged home on the 12th postoperative day. Placement of a pacemaker was not required because the patient retained the sinus rhythm. A review of the literature on cardiac autotransplantation revealed that this type of surgery has been performed frequently in centers that have a cardiac transplantation program or a surgeon who has cardiac transplantation experience. To our knowledge, this report is the first of cardiac autotransplantation for benign hemangioma.
我们描述了一名出现严重充血性心力衰竭症状患者的治疗过程。一名48岁男性最初在急诊室就诊，随后入院，并接受了经胸超声心动图、经食管超声心动图以及胸部计算机断层扫描检查。所有心脏瓣膜均正常，左心室射血分数也正常。发现一个大小为6×4×5厘米的可移动左心房肿瘤附着于左心房穹窿、左心房袖口和左肺静脉。每次心房收缩期，肿块经二尖瓣环脱垂入左心室，产生19毫米汞柱的压力阶差。对该患者的检查未发现恶性病变。对于该患者，唯一可行的治疗方法是在体外循环和心脏停搏下切除肿块。手术时，检查结果证实肿块广泛附着于左心房穹窿壁 - 心外膜，其附着情况与经食管超声心动图检查结果相似。心房附着部位从心脏底部开始，沿着房室沟、左心房左穹窿、左心房袖口以及双侧左肺静脉的前部延伸。肿瘤无法充分切除，且在心脏原位时无法对缺损进行重建。因此，我们决定取出心脏并在距肿瘤边缘0.5厘米的健康组织处切除肿瘤。用牛心包重建了广泛的左心房缺损。重建范围包括左心房穹窿、左心房袖口和肺静脉。心脏重新植入心包腔。还吻合了保留窦房结的上腔静脉。病理诊断为良性海绵状血管瘤。移除主动脉阻断钳并对心脏进行再灌注后，窦性心律恢复。患者恢复迅速，术后第12天出院。由于患者保留了窦性心律，因此无需植入起搏器。对心脏自体移植文献的回顾显示，这种手术在有心脏移植项目或有心脏移植经验的外科医生的中心经常进行。据我们所知，本报告是首例因良性血管瘤进行心脏自体移植的病例。
