González L Roberto, Reyes M Rodrigo, Riquelme U Alejandra, Seguel S Enrique, Stockins L Aleck, Jadue T Andrés, Alarcón C Emilio
Centro Cardiovascular, Hospital Clínico Regional de Concepción "Dr. Guillermo Grant Benavente", Concepción, Chile.
Departamento de Cirugía, Facultad de Medicina, Universidad de Concepción, Concepción, Chile.
Rev Med Chil. 2019 Feb;147(2):243-246. doi: 10.4067/s0034-98872019000200243.
Embolic stroke secondary to cardiac tumors is uncommon. However, 25-30% of cardiac tumors may cause systemic emboli. We report a 29-year-old male consulting for a sudden episode of aphasia and right hemiparesis, compatible with infarct of the left middle cerebral artery territory. Transthoracic echocardiography reported an ovoid tumor of 8 × 7 × 7 mm in relation to the sub valvular apparatus of the mitral valve. After neurologic stabilization, surgical treatment was performed. Approached by median sternotomy and in cardiopulmonary bypass, the mitral valve was explored. A macroscopic tumor consistent with a papillary fibroelastoma curled in sub valvular chordae was found. It was deployed and resected from its base, while the anterior mitral leaflet was preserved intact. Histopathological examination confirmed the intraoperative macroscopic diagnosis. The patient recovered uneventfully postoperatively and was discharged on the fifth day after surgery. He currently is in functional capacity I without cardiovascular symptoms at five years follow-up.
心脏肿瘤继发的栓塞性中风并不常见。然而，25% - 30%的心脏肿瘤可能会引起全身性栓塞。我们报告一例29岁男性，因突发失语和右侧偏瘫前来就诊，符合左大脑中动脉区域梗死表现。经胸超声心动图报告在二尖瓣瓣下装置处有一个8×7×7毫米的椭圆形肿瘤。在神经功能稳定后，进行了手术治疗。通过正中胸骨切开术并在体外循环下，对二尖瓣进行探查。发现一个与乳头状纤维弹性瘤相符的肉眼可见肿瘤，卷曲在瓣下腱索中。将其展开并从基部切除，同时二尖瓣前叶保持完整。组织病理学检查证实了术中的肉眼诊断。患者术后恢复顺利，术后第五天出院。在五年随访中，他目前功能状态为I级，无心血管症状。
