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右心房成熟心肌细胞错构瘤:一例报告及文献复习

Hamartoma of mature cardiomyocytes in right atrium: A case report and literature review.

作者信息

Zhou Xinqi, Zhou Yangzhao, Zhaoshun Yuan, Zeng Mu, Zhou Xinmin, Liao Xiaobo, Zhang Zhiyuan

机构信息

Department of Cardiovascular Surgery.

Department of radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.

出版信息

Medicine (Baltimore). 2019 Aug;98(31):e16640. doi: 10.1097/MD.0000000000016640.

Abstract

RATIONALE

Tumors in the heart are rare. Myxomas, rhabdomyomas, and fibromas are the most common benign cardiac tumors. Hamartoma of mature cardiomyocytes (HMCM) is another benign cardiac tumor, are very rare and have only been reported in a few literatures.

PATIENT CONCERNS

We report a case of 41-year-old male who suffered short of breath for 3 years, and lower limbs edema for 2 years.

DIAGNOSES

Transthoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) showed a large amount of pericardial effusion and confirmed a mass of 18 × 14 mm on the superior vena cava near the outer edge of right atrium. The patient was first diagnosed as pleural mesothelioma. Surgery was performed to relieve the symptoms and confirm diagnoses. However, during surgery, we found the right atrium is apparently thicken with rough and uneven surface. Histology of right atrium mass indicated it as hamartoma of mature cardiomyocytes.

INTERVENTION

We resected the thicken atrial wall completely, reconstructed right atrium with bovine pericardial patch, and resected the pericardium.

OUTCOMES

Patient was discharged 9 days after surgery, and remained asymptomatic during 9 months follow up.

LESSONS

Hamartoma of mature cardomyocytes is a rare benign cardiac tumor. There were 26 cases reported until now. The conclusive diagnosis depends on pathological sections. For patients with symptoms, surgery is an effective treatment for HMCM.

摘要

原理

心脏肿瘤较为罕见。黏液瘤、横纹肌瘤和纤维瘤是最常见的良性心脏肿瘤。成熟心肌细胞错构瘤(HMCM)是另一种良性心脏肿瘤,非常罕见,仅在少数文献中有报道。

患者情况

我们报告一例41岁男性,有3年气短、2年下肢水肿病史。

诊断

经胸超声心动图(TTE)和心脏磁共振成像(CMR)显示大量心包积液,并证实右心房外缘附近上腔静脉有一个18×14mm的肿块。该患者最初被诊断为胸膜间皮瘤。进行手术以缓解症状并明确诊断。然而,手术过程中,我们发现右心房明显增厚,表面粗糙且凹凸不平。右心房肿块组织学检查显示为成熟心肌细胞错构瘤。

干预措施

我们完整切除增厚的心房壁,用牛心包补片重建右心房,并切除心包。

结果

患者术后9天出院,随访9个月期间无症状。

经验教训

成熟心肌细胞错构瘤是一种罕见的良性心脏肿瘤。目前共报道26例。确诊依赖病理切片。对于有症状的患者,手术是治疗HMCM的有效方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/015f/6709070/d093b16e6d74/medi-98-e16640-g001.jpg

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