Gupta Prabha Nini, Sagar Nishant, Ramachandran Ritesh, Rajeshekharan Velenurre Rajagopalan
Department of Cardiology, Medical College Hospital, Trivandrum, Kerala, India.
BMJ Case Rep. 2019 Feb 25;12(2):e225900. doi: 10.1136/bcr-2018-225900.
Myxoma is a common benign tumour found in the heart. On reviewing literature, we found some left atrial myxomas receive blood supply from the right coronary artery. Performing a coronary angiogram in a cardiac tumour has the following uses: (1) it shows the vascularity that can be ligated by the surgeon at operation; (2) if there is a blood supply visible, it may not be an intracardiac thrombus; (3) the coronary angiogram may detect a myxoma even before an echocardiogram does so; (4) some myxomas may bleed into the right atrium or left atrium and this may be seen on coronary angiography. We show here the neovascularity of a left atrial myxoma and its blood supply from the right coronary artery. We recommend that all routine coronary angiograms be reviewed carefully for any signs of tumour vascularity or tumour blush as this would prevent missing early myxomas. Echocardiography is the gold standard for detection of myxomas but literature has a number of intracardiac tumours that were detected only by the tumour blush. Some left atrial tumours have been treated by occluding their blood supply.The absence of a blood supply on coronary angiography could rule out a benign cardiac tumour that usually has a blood supply.
黏液瘤是一种常见的心脏良性肿瘤。查阅文献时，我们发现一些左心房黏液瘤由右冠状动脉供血。对心脏肿瘤进行冠状动脉造影有以下作用：（1）显示手术中外科医生可结扎的血管；（2）若可见血供，则可能不是心内血栓；（3）冠状动脉造影甚至可能在超声心动图之前检测到黏液瘤；（4）一些黏液瘤可能会出血进入右心房或左心房，这在冠状动脉造影中可能会被发现。我们在此展示了左心房黏液瘤的新生血管及其来自右冠状动脉的血供。我们建议仔细复查所有常规冠状动脉造影，寻找肿瘤血管或肿瘤染色的任何迹象，因为这可防止漏诊早期黏液瘤。超声心动图是检测黏液瘤的金标准，但文献中有一些心内肿瘤仅通过肿瘤染色才被发现。一些左心房肿瘤已通过阻断其血供进行治疗。冠状动脉造影上无血供可排除通常有血供的良性心脏肿瘤。
