Iizuka Hirofumi, Aoki Atushi, Omoto Tadashi, Maruta Kazuto, Sakurai Sigeru, Kawaura Hiromasa
Department of Cardiovascular Surgery, Showa University, School of Medicine, Tokyo, Japan.
Kyobu Geka. 2014 Sep;67(10):919-22.
In patients with left atrial myxoma, mitral valve regurgitation is often encountered. However, preoperative assessment of the mitral valve is difficult in cases with giant left atrial myxoma occupying the left atrial cavity. We experienced a patient with giant left atrial myxoma who underwent tumor excision and mitral valve repair. A 40-year-old woman was transferred to the emergency room due to respiratory failure. On admission, her hemodynamic status was unstable and percutaneous cardiopulmonary support was immediately started. Transesophageal echocardiography was performed, which showed giant left atrial tumor with the pedicle on the atrial septum with mitral valve regurgitation, but the severity of regurgitation was unclear. After excision of left atrial myxoma with atrial septum, the mitral valve was examined. The anterior leaflet( A3 scallop) prolapse due to a torn chordae was found. The mitral valve was repaired with leaflet resection and prosthetic ring annuloplasty. Postoperative course was uneventful and postoperative echocardiography showed no residual mitral valve regurgitation. The mitral valve should be carefully inspected intraoperatively after resection of left atrial myxoma, especially when the tumor is gigantic.
在左心房黏液瘤患者中,常可遇到二尖瓣反流。然而,对于巨大左心房黏液瘤占据左心房腔的病例,术前评估二尖瓣较为困难。我们遇到一位患有巨大左心房黏液瘤的患者,该患者接受了肿瘤切除及二尖瓣修复手术。一名40岁女性因呼吸衰竭被转入急诊室。入院时,她的血流动力学状态不稳定,立即启动了经皮心肺支持。进行了经食管超声心动图检查,结果显示巨大左心房肿瘤,蒂位于房间隔,伴有二尖瓣反流,但反流的严重程度尚不清楚。在切除左心房黏液瘤及房间隔后,对二尖瓣进行了检查。发现前叶(A3扇贝形)因腱索撕裂而脱垂。通过瓣叶切除和人工瓣环成形术对二尖瓣进行了修复。术后过程顺利,术后超声心动图显示无残余二尖瓣反流。在切除左心房黏液瘤后,术中应仔细检查二尖瓣,尤其是当肿瘤巨大时。