Roque J, Silva F, Arruda Pereira R, Cravino J
Department of Cardiothoracic Surgery, Hospital de Santa Maria, Lisbon, Portugal.
HSR Proc Intensive Care Cardiovasc Anesth. 2012;4(3):187-91.
We report a case in which multiple uncommon causes of an ischemic vascular accident coexisted in the same patient. The patient was admitted with signs of acute stroke. Investigation workup revealed a left atrial tumor (myxoma) and a patent foramen ovale. Intraoperatively, transesophageal echocardiography added new information: papillary fibroelastomas were found in the aortic valve. This finding dictated a change in the surgical plan, adding resection of aortic valve masses to the planned excision of the left atrial tumor and patent foramen ovale closure. The uniqueness of this case derives from the coexistence of rare primary cardiac tumors. There are only five cases in literature of myxoma concomitant with fibroelastoma and the occurrence of multiple fibroelastoma is also extremely rare. Moreover this case emphasizes the benefit of the intraoperative use of transesophageal echocardiography to improve the diagnosis and management of cardiac surgical patients.
我们报告了一例同一患者同时存在多种罕见缺血性血管意外病因的病例。该患者因急性中风症状入院。检查发现左心房肿瘤（黏液瘤）和卵圆孔未闭。术中，经食管超声心动图提供了新信息：在主动脉瓣发现了乳头状纤维弹性瘤。这一发现促使手术方案发生改变，在计划切除左心房肿瘤和闭合卵圆孔未闭的基础上，增加了主动脉瓣肿物切除术。该病例的独特之处在于罕见的原发性心脏肿瘤并存。文献中仅有5例黏液瘤合并纤维弹性瘤的病例，且多发纤维弹性瘤的发生也极为罕见。此外，该病例强调了术中使用经食管超声心动图对改善心脏手术患者诊断和管理的益处。
