Department of Anesthesiology, Peking University People's Hospital, No. 11 Xi Zhi Men Nan Da Jie, Xicheng District, Beijing, China.
Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, USA.
BMC Anesthesiol. 2020 Jul 4;20(1):164. doi: 10.1186/s12871-020-01055-1.
Embolic stroke is a common complication of atrial myxoma, whereas multiple cerebral aneurysms associated with atrial myxoma is rare. The pathogenesis of the cerebral vascular disease related to an atrial myxoma is still not well known, and there are no guidelines to guide treatment and anesthesia management in such patients.
In this report, we present a 38-year-old woman with occasional dizziness and headache diagnosed as multiple cerebral fusiform aneurysms, in whom transthoracic echocardiography revealed a mass attached to the interatrial septum in the left atrium. Myxoma resection was performed in fast track cardiac surgery pathway without neurological complications, and no intervention was carried out on the cerebral aneurysms. She was discharged home 6 days after the procedure for followed-up. Furthermore, we reviewed and analyzed the literature in the PubMed and Google Scholar databases in order to conclude the optimal treatment in such cases.
Atrial myxoma-related cerebral aneurysms are always multiple and in a fusiform shape in most occasions. Early resection of myxoma and conservative therapy of aneurysm is an optimal treatment. TEE and PbtO monitoring play an essential role in anesthesia management. Fast track cardiac anesthesia is safe and effective to early evaluate neurological function. Long term follow-up for "myxomatous aneurysms" is recommended. And outcome of most patients is excellent.
脑栓塞是心房黏液瘤的常见并发症，而与心房黏液瘤相关的多发性脑动脉瘤则较为罕见。与心房黏液瘤相关的脑血管疾病的发病机制尚不清楚，也没有指南来指导此类患者的治疗和麻醉管理。
本报告介绍了 1 例 38 岁女性患者，偶有头晕和头痛，诊断为多发性脑梭形动脉瘤。经胸超声心动图显示左心房房间隔上附有 1 个肿块。在快速心脏手术通道中进行了黏液瘤切除术，无神经并发症，脑动脉瘤未进行干预。术后 6 天，患者出院回家进行随访。此外，我们在 PubMed 和 Google Scholar 数据库中对文献进行了回顾和分析，以总结此类病例的最佳治疗方法。
心房黏液瘤相关的脑动脉瘤通常在大多数情况下是多发性的，呈梭形。早期切除黏液瘤和保守治疗动脉瘤是最佳治疗方法。TEE 和 PbtO 监测在麻醉管理中发挥着重要作用。快速通道心脏麻醉术安全有效，可早期评估神经功能。建议对“黏液瘤性动脉瘤”进行长期随访。大多数患者的预后良好。
