Division of Cardiac Surgery and First Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Donato Hospital, San Donato Milanese, and Faculty of Medicine, University of Milan, Milan, Italy.
Ann Thorac Surg. 2012 Mar;93(3):825-31. doi: 10.1016/j.athoracsur.2011.11.009. Epub 2012 Jan 31.
Primary cardiac tumors are quite uncommon and myxomas constitute the major proportion among these masses. The present study summarizes our 20-year clinical experience with surgical resection of intracardiac myxomas.
Between January 1990 and December 2007, 98 patients (42 males, mean age 60.4±4.1 years) underwent complete excision of primary intracardiac myxoma. In 84 patients the origin site of the tumor was located in the left atrium, and the most common implant site was the interatrial septum. The most common symptom at admission was dyspnea, while systemic embolization was observed in 37 patients. Preoperative diagnosis was established in all patients by transthoracic echocardiography. All patients were operated through median sternotomy.
Ninety-five patients (97%) survived the operation. Mean tumor dimension was 2.7±1.3 cm in largest diameter. According to the St. John Sutton classification (St. John Sutton MG, Mercier LA, Giuliani ER, et al. Atrial myxomas: a review of clinical experience in 40 patients. Mayo Clin Pro 1980;55:371-6), solid tumors were detected in 43 patients (44%), while a papillary myxoma was found in 55 patients (56%). The follow-up was 100% complete, and the mean time to last follow-up was 98±60 months. Of the 95 survivors, 3 patients (3%) died at a mean follow-up of 72±45 months after surgery. Actuarial survival was 98%, 98%, and 89% at 5, 10, and 15 years, respectively. One patient operated for left atrial myxoma resection showed a recurrence 68 months after the first surgery.
Although cardiac myxomas carry the risk of severe systemic and cardiac symptoms, prompt surgical excision gives excellent early and long-term results.
原发性心脏肿瘤较为罕见，其中黏液瘤占大多数。本研究总结了我们 20 年来手术切除心脏黏液瘤的临床经验。
1990 年 1 月至 2007 年 12 月，98 例患者（男 42 例，平均年龄 60.4±4.1 岁）接受了原发性心脏内黏液瘤的完全切除术。在 84 例患者中，肿瘤起源部位位于左心房，最常见的植入部位是房间隔。最常见的入院症状是呼吸困难，37 例患者观察到全身栓塞。所有患者均通过经胸超声心动图术前诊断。所有患者均通过正中胸骨切开术进行手术。
95 例（97%）患者手术存活。最大直径的平均肿瘤尺寸为 2.7±1.3cm。根据圣约翰·萨顿分类（St. John Sutton MG、Mercier LA、Giuliani ER 等人。心房黏液瘤：40 例临床经验回顾。梅奥临床普罗 1980；55：371-6），43 例患者（44%）发现实体瘤，55 例患者（56%）发现乳头状黏液瘤。随访率为 100%，最后一次随访的平均时间为 98±60 个月。在 95 例存活者中，3 例（3%）患者在术后 72±45 个月的平均随访时间内死亡。术后 5、10 和 15 年的存活率分别为 98%、98%和 89%。1 例因左心房黏液瘤切除而接受手术的患者在首次手术后 68 个月出现复发。
尽管心脏黏液瘤存在严重全身和心脏症状的风险，但及时手术切除可获得良好的早期和长期结果。
