Aoyagi Shigeaki, Fukunaga Shuji, Kosuga Tomokazu, Akashi Hidetoshi
Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
Ann Thorac Cardiovasc Surg. 2011;17(4):411-4. doi: 10.5761/atcs.cr.10.01582.
A 73-year-old woman was referred for treatment of left atrial (LA) myxoma. At surgery, a myxoma was attached to the left atrial side of the fossa ovalis in the atrial septum by a stalk and was transmurally excised with a margin of the atrial septum. The atrial septum was closed without any prosthetic materials under mild to moderate tension. Although she was asymptomatic, postoperative transesophageal echocardiography (TEE) revealed an abnormal cavity, containing heterogeneous echogenesity without blood flow, in the posterior LA wall. Magnetic resonance imaging (MRI) demonstrated a mass without significant enhancement. It was considered to be an intramural hematoma, and the diagnosis of LA dissection was made. Follow-up echocardiography showed disappearance of the dissected lumen without surgical intervention. Both TEE and MRI are useful for the correct diagnosis of an LA dissection; and surgical intervention, entry closure or internal drainage, may not always be necessary in the absence of a hemodynamic compromise with an LA dissection.
一名73岁女性因治疗左心房黏液瘤前来就诊。手术中，一个黏液瘤通过蒂附着于房间隔卵圆窝的左心房侧，并连同房间隔边缘进行了全层切除。房间隔在轻度至中度张力下未使用任何人工材料进行了闭合。尽管她没有症状，但术后经食管超声心动图（TEE）显示左心房后壁有一个异常腔隙，内含不均匀回声且无血流。磁共振成像（MRI）显示有一个无明显强化的肿块。考虑为壁内血肿，诊断为左心房夹层。随访超声心动图显示夹层腔隙在未进行手术干预的情况下消失。TEE和MRI对于正确诊断左心房夹层均有用；在左心房夹层未出现血流动力学障碍时，手术干预、入口闭合或内部引流可能并非总是必要的。
