Madjarov Jeko M, Katz Michael G, Madjarova Sophia, Madzharov Svetozar, Arko Frank R, Miller David W, Robicsek Francis
Department of Cardio-Vascular Surgery, Sanger Heart & Vascular Institute, Charlotte, NC.
Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY.
Ann Vasc Surg. 2018 Oct;52:314.e17-314.e20. doi: 10.1016/j.avsg.2018.03.035. Epub 2018 May 22.
An anomalous muscle bundle (AMB) crossing the right atrial cavity represents a pathologic finding with unproved clinical significance. This congenital anomaly may be difficult to recognize via echocardiography and could be confused with other intracavitary lesions.
We report the case of a 53-year-old woman presented to the cardiovascular service with acute superior vena cava (SVC) syndrome and submassive pulmonary embolism.
The patient underwent venography, confirming SVC stenosis. A ventilation/perfusion lung scan showed 2 sizable perfusion defects because of pulmonary embolism. Magnetic resonance imaging and echocardiography imaging demonstrated a right atrium (RA) mass. Surgery was then carried out using standard cardiopulmonary bypass; the right atrial muscle bundle was excised, and SVC reconstruction was performed. The patient was discharged uneventfully and remains symptom-free at 2-year follow-up.
In cases of nonmalignant pathology of SVC syndrome, appropriate studies should be conducted to exclude potential congenital abnormalities such as this AMB in the RA. Open-heart surgery is a viable treatment option in select cases.
一条穿过右心房腔的异常肌束（AMB）是一种病理表现，其临床意义尚未得到证实。这种先天性异常可能难以通过超声心动图识别，并且可能与其他心腔内病变相混淆。
我们报告了一名53岁女性的病例，该患者因急性上腔静脉（SVC）综合征和次大面积肺栓塞就诊于心血管科。
患者接受了静脉造影，证实存在SVC狭窄。通气/灌注肺扫描显示由于肺栓塞导致2个较大的灌注缺损。磁共振成像和超声心动图显示右心房（RA）有肿物。然后使用标准体外循环进行手术；切除右心房肌束，并进行SVC重建。患者顺利出院，在2年随访时仍无症状。
在SVC综合征的非恶性病变病例中，应进行适当的检查以排除潜在的先天性异常，如RA中的这种AMB。在某些特定病例中，心脏直视手术是一种可行的治疗选择。
