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患有黏液瘤的孕妇术前出现栓子

Preoperative Emboli in a Pregnant Woman with Myxoma.

作者信息

Sabzi Freidoun, Faraji Reza

机构信息

Preventive Cardiovascular Research Centre Kermanshah, Kermanshah University of Medical Sciences, Kermanshah, Iran.

出版信息

Iran J Med Sci. 2016 Jul;41(4):345-9.

Abstract

The left atrium is the most common location of myxomas, which are benign tumors. Only a few cases of myxomas in pregnancies have been reported. Our thorough medical literature search showed only 17 reported cases in the course of pregnancy. Myxomas during pregnancy and in the preterm period constitute a serious phenomenon that can mimic an early sign of a life-threatening pathology like severe mitral stenosis. We describe a 33-year-old woman, who presented with acute dyspnea to a gynecology center and was referred to our hospital for further evaluation of pulmonary embolism. Transthoracic echocardiography showed a huge left atrial myxoma, and computed tomography scan illustrated paradoxical pulmonary embolism in the left upper lung lobe via a large patent foramen ovale. The tumor required urgent cardiac surgery. In this article, we review causes of dyspnea in pregnancy and the cardiovascular effects of myxomas in pregnancy. We also describe the pathophysiological effects of cardiopulmonary bypass on the mother, fetus, and the feto-placental system during open-heart surgery. We performed a successful surgical resection of a myxoma in a pregnant woman. Given the rarity of such cases, individual multidisciplinary assessment and management strategies are essential.

摘要

左心房是黏液瘤(一种良性肿瘤)最常见的发生部位。仅有少数妊娠期黏液瘤病例的报道。我们全面检索医学文献后发现,妊娠期黏液瘤仅有17例报道。妊娠期及早产期的黏液瘤是一种严重的情况,可能会被误诊为诸如严重二尖瓣狭窄等危及生命的病理状况的早期迹象。我们描述了一名33岁女性,她因急性呼吸困难前往妇科中心就诊,后被转诊至我院进一步评估肺栓塞情况。经胸超声心动图显示巨大的左心房黏液瘤,计算机断层扫描显示通过一个大的心房间隔卵圆孔未闭,左上肺叶存在矛盾性肺栓塞。该肿瘤需要紧急心脏手术。在本文中,我们回顾了妊娠期呼吸困难的原因以及妊娠期黏液瘤对心血管系统的影响。我们还描述了心脏直视手术期间体外循环对母亲、胎儿及胎儿 - 胎盘系统的病理生理影响。我们成功地为一名孕妇切除了黏液瘤。鉴于此类病例罕见,个体化的多学科评估和管理策略至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/af40/4912655/e34e72debff9/IJMS-41-345-g001.jpg

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