Department of Cardiovascular Surgery, Chinese PLA General Hospital, No.28. Fuxing Road, Haidian District, Beijing, 100853, China.
J Cardiothorac Surg. 2021 Jun 7;16(1):164. doi: 10.1186/s13019-021-01535-6.
Intracardiac blood cysts are very rare primary cardiac tumors. Blood cysts originated from the mitral valve represent a minority of cases, and previous cases have been mainly treated with conventional surgery through median sternotomy. When the tumor involves heart valves and histopathological diagnosis remains unknown preoperatively, minimally invasive surgical resection of an intracardiac tumor can be challenging, especially through an endoscopic approach. We herein present the first case of successful surgical resection for a rare mitral valve originated blood cyst in a minimally invasive, totally thoracoscopic approach.
An apparently healthy 38-year-old male presented to his local hospital with six months history of palpitation and exertional dyspnea. Transthoracic echocardiography showed a mobile round cystic mass inside the left ventricle, attached to the anterolateral papillary muscle and chordae tendineae of the mitral valve. The local doctor diagnosed an intracardiac tumor and suggested a surgical resection through median sternotomy. However, the patient refused to have a sternotomy. He was then referred to us seeking minimally invasive surgery. We assessed the location, appearance and relationship to nearby structures of the tumor with echocardiography, and made a diagnosis of a suspected primary cystic intracardiac tumor. Since we had enough experience of totally endoscopic mitral surgery, our surgical plan was to resect the tumor in the aid of thoracoscopy, and manage the possible deformation and dysfunction of the cardiac structure if necessary. Using femoro-femoral cannulation and cardiopulmonary bypass, we successfully resected the tumor through a thoracoscopic approach in a closed chest, and well preserved the subvalvular structure and valvular function. Postoperative recovery was quick and uneventful. Pathologic diagnosis confirmed a simple blood cyst.
Surgical resection is warranted for symptomatic cases of intracardiac blood cysts. With prudent preoperative diagnosis and comprehensive surgical plan, we believe the thoracoscopic approach is a safe, curative and viable alternative for complete resection of cardiac valvular tumors.
心内血囊肿是非常罕见的原发性心脏肿瘤。起源于二尖瓣的心内血囊肿占少数病例，以往的病例主要通过正中开胸的传统手术治疗。当肿瘤累及心脏瓣膜且术前病理诊断不明时，微创切除心内肿瘤具有挑战性，特别是通过内镜方法。本文报告首例通过微创、全胸腔镜方法成功切除罕见的二尖瓣起源血囊肿。
一位 38 岁的健康男性，因六个月心悸和劳力性呼吸困难就诊于当地医院。经胸超声心动图显示左心室内部有一个可移动的圆形囊性肿块，附着于前外侧乳头肌和二尖瓣的腱索上。当地医生诊断为心内肿瘤，并建议通过正中开胸进行手术切除。然而，患者拒绝开胸手术。随后他被转介给我们，寻求微创治疗。我们通过超声心动图评估肿瘤的位置、外观和与周围结构的关系，并诊断为疑似原发性囊性心内肿瘤。由于我们有丰富的全内镜二尖瓣手术经验，我们的手术计划是在胸腔镜辅助下切除肿瘤，并在必要时处理心脏结构的可能变形和功能障碍。通过股股插管和体外循环，我们成功地在闭合胸腔内通过胸腔镜途径切除了肿瘤，并很好地保留了瓣下结构和瓣膜功能。术后恢复迅速且顺利。病理诊断证实为单纯性血囊肿。
对于有症状的心内血囊肿病例，应进行手术切除。通过谨慎的术前诊断和全面的手术计划，我们相信胸腔镜方法是切除心脏瓣膜肿瘤的安全、治愈和可行的替代方法。
