Papadopoulos Konstantinos, Alexiou Christos, Ozden Tok Ozge, Vannan Mani A
Echocardiography Laboratory, European Interbalkan Medical Center, Asklypiou 10 str, Pylaia, Thessaloniki 57001, Greece.
Department of Cardiothoracic Surgery, European Interbalkan Medical Center, Asklypiou 10 str, Pylaia, Thessaloniki 57001, Greece.
Eur Heart J Case Rep. 2020 Dec 12;4(6):1-4. doi: 10.1093/ehjcr/ytaa476. eCollection 2020 Dec.
Atrial myxomas are the most common benign cardiac tumours. Clinical manifestations vary from constitutional symptoms, to valvular stenosis and embolic events, and surgical removal is the only suggested treatment.
A 50-year-old female patient was referred to our centre for surgical excision of a reported right atrial mass. A transoesophageal echocardiographic exam revealed two right atrial masses and the surgical plan was total removal of both masses. However, during the operation the surgeons were not able to locate the larger of the two masses and embolization to the pulmonary trunk was considered as the most likely explanation in this setting. A control suction of the right ventricle and the proximal part of the pulmonary arteries was performed to check if the mass had embolized distally but this did not yield any mass. The patient was transferred to the intensive care unit and remained stable for 2 h, until she developed an abrupt cardiogenic shock with signs of right heart failure. An emergent pulmonary computed tomography angiography demonstrated the embolized mass to the left pulmonary artery and the patient was retransferred to the operating room for emergent surgical removal of the mass. The patient showed immediate clinical and haemodynamic improvement after the removal of this mass and had an uneventful further hospitalization.
Multiple right atrial myxomas are rarely reported and surgical excision requires experience, as in case of embolization immediate removal must be obtained to prevent from right ventricle distress and cardiogenic shock.
心房黏液瘤是最常见的心脏良性肿瘤。临床表现多样，从全身症状到瓣膜狭窄和栓塞事件，手术切除是唯一建议的治疗方法。
一名50岁女性患者因报告的右心房肿块被转诊至我们中心进行手术切除。经食管超声心动图检查发现两个右心房肿块，手术计划是将两个肿块全部切除。然而，手术过程中外科医生未能找到两个肿块中较大的那个，在这种情况下，肺动脉主干栓塞被认为是最可能的解释。对右心室和肺动脉近端进行了控制性抽吸，以检查肿块是否已向远端栓塞，但未发现任何肿块。患者被转入重症监护病房，在2小时内保持稳定，直到突然出现心源性休克并伴有右心衰竭的迹象。紧急肺部计算机断层扫描血管造影显示肿块栓塞至左肺动脉，患者被再次转入手术室进行紧急手术切除肿块。切除该肿块后，患者立即出现临床和血流动力学改善，随后住院过程顺利。
多发性右心房黏液瘤很少见，手术切除需要经验，因为如果发生栓塞，必须立即切除以防止右心室窘迫和心源性休克。
