Hata Masatoshi, Gummert Jan F, Börgermann Jochen, Hakim-Meibodi Kavous
Department of Cardiothoracic Surgery, Heart and Diabetes Center North-Rhine Westphalia, Ruhr-University Bochum, Georgstrasse 11, 32545 Bad Oeynhausen, Germany.
J Cardiothorac Surg. 2013 Dec 11;8:227. doi: 10.1186/1749-8090-8-227.
Cardiac myxomas are one of the most common types of primary cardiac tumors and are associated with embolization, angina, and sudden death. Most cardiac myxomas arise from the fossa ovalis, while those that arise from the mitral valve are exceedingly rare and those that arise from the chordae are even rarer. We report the case of a 28-year-old Caucasian woman who suffered from a brain infarction. A duplex ultrasound showed no cerebrovascular stenosis or occlusion, but an echocardiogram revealed a left ventricle pedunculated mobile mass (5 mm in diameter) that was attached to the mitral valve chordae tendineae. We elected cardiac surgery to resect the cardiac tumor and to avoid further embolic events. The traditional surgical strategy-mitral valve replacement through full sternotomy-has many disadvantages, particularly for young women. Therefore we desided to use the Premeasured Gore-Tex chordal loop method followed by annuloplasty using a minimally invasive video-assisted approach. Exploration of the mitral valve showed a globular tumor involving the anterior mitral leaflet chordae tendineae, which was removed along with the involved chordae tendineae. Histopathological examination of the tissue revealed a benign polypoid myxoma. The patient had an uneventful recovery and has remained symptom-free.Echocardiography one week after surgery showed satisfactory valve function. We believe our surgical treatment was the most appropriate option for this case and it resulted in an excellent medical outcome and improved the quality of life, including only a small lateral scar without the need for teratogenic anticoagulants.
心脏黏液瘤是最常见的原发性心脏肿瘤类型之一,与栓塞、心绞痛和猝死有关。大多数心脏黏液瘤起源于卵圆窝,而起源于二尖瓣的极为罕见,起源于腱索的则更为罕见。我们报告一例28岁白人女性脑梗死病例。双功超声显示无脑血管狭窄或闭塞,但超声心动图显示左心室有一蒂状可移动肿物(直径5毫米)附着于二尖瓣腱索。我们选择心脏手术切除心脏肿瘤以避免进一步的栓塞事件。传统的手术策略——通过全胸骨切开术置换二尖瓣——有许多缺点,尤其是对年轻女性。因此,我们决定采用预先测量的戈尔特斯(Gore-Tex)腱索环法,然后采用微创视频辅助方法进行瓣环成形术。对二尖瓣的探查显示一个球形肿瘤累及二尖瓣前叶腱索,连同受累腱索一并切除。组织的组织病理学检查显示为良性息肉状黏液瘤。患者恢复顺利,至今无症状。术后一周的超声心动图显示瓣膜功能良好。我们认为我们的手术治疗是该病例最合适的选择,它带来了良好的医疗结果并改善了生活质量,包括仅有一个小的侧方瘢痕且无需致畸性抗凝剂。