妊娠期心脏黏液瘤：全面综述
Cardiac myxoma in pregnancy: a comprehensive review.
作者信息
Yuan Shi-Min
机构信息
The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, CN.
出版信息
Rev Bras Cir Cardiovasc. 2015 Jul-Sep;30(3):386-94. doi: 10.5935/1678-9741.20150012.
OBJECTIVE
Cardiac myxoma in pregnancy is rare and the clinical characteristics of this entity have been insufficiently elucidated. This article aims to describe the treatment options and the risk factors responsible for the maternal and feto-neonatal prognoses.
METHODS
A comprehensive search of the literature of cardiac myxoma in pregnancy was conducted and 44 articles with 51 patients were included in the present review.
RESULTS
Transthoracic echocardiography was the most common diagnostic tool for the diagnosis of cardiac myxoma during pregnancy. Cardiac myxoma resection was performed in 95.9% (47/49); while no surgical resection was performed in 4.1% (2/49) patients (P=0.000). More patients had an isolated cardiac myxoma resection in comparison to those with a concurrent or staged additional cardiac operation [87.2% (41/47) vs. 12.8% (6/47), P=0.000]. A voluntary termination of the pregnancy was done in 7 (13.7%) cases. In the remaining 31 (60.8%) pregnant patients, cesarean section was the most common delivery mode representing 61.3% and vaginal delivery was more common accounting for 19.4%. Cardiac surgery was performed in the first, second and third trimester in 5 (13.9%), 14 (38.9%) and 17 (47.2%) patients, respectively. No patients died. In the delivery group, 20 (76.9%) neonates were event-free survivals, 4 (15.4%) were complicated and 2 (7.7%) died. Neonatal prognoses did not differ between the delivery modes, treatment options, timing of cardiac surgery and sequence of cardiac myxoma resection in relation to delivery.
CONCLUSION
The diagnosis of cardiac myxoma in pregnancy is important. Surgical treatment of cardiac myxoma in the pregnant patients has brought about favorable maternal and feto-neonatal outcomes in the delivery group, which might be attributable to the shorter operation duration and non-emergency nature of the surgical intervention. Proper timing of cardiac surgery and improved cardiopulmonary bypass conditions may result in even better maternal and feto-neonatal survivals.
目的
妊娠合并心脏黏液瘤较为罕见，该疾病的临床特征尚未得到充分阐明。本文旨在描述治疗方案以及影响母婴和胎儿 - 新生儿预后的危险因素。
方法
对妊娠合并心脏黏液瘤的文献进行全面检索，本综述纳入了44篇文章中的51例患者。
结果
经胸超声心动图是孕期诊断心脏黏液瘤最常用的诊断工具。49例患者中，95.9%（47/49）进行了心脏黏液瘤切除术；4.1%（2/49）的患者未进行手术切除（P = 0.000）。与同期或分期进行其他心脏手术的患者相比，单纯进行心脏黏液瘤切除术的患者更多[87.2%（41/47）对12.8%（6/47），P = 0.000]。7例（13.7%）患者自愿终止妊娠。在其余31例（60.8%）妊娠患者中，剖宫产是最常见的分娩方式，占61.3%，阴道分娩更常见，占19.4%。分别有5例（13.9%）、14例（38.9%）和17例（47.2%）患者在孕早期、孕中期和孕晚期进行了心脏手术。无患者死亡。在分娩组中，20例（76.9%）新生儿无不良事件存活，4例（15.4%）出现并发症，2例（7.7%）死亡。分娩方式、治疗方案、心脏手术时机以及心脏黏液瘤切除与分娩的顺序对新生儿预后无差异。
结论
妊娠合并心脏黏液瘤的诊断很重要。对妊娠患者进行心脏黏液瘤手术治疗在分娩组中带来了良好的母婴和胎儿 - 新生儿结局，这可能归因于手术时间较短以及手术干预的非紧急性质。合适的心脏手术时机和改善体外循环条件可能会使母婴和胎儿 - 新生儿存活率更高。
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