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左心房黏液瘤与短暂性脑缺血发作:病例报告

Left atrial myxoma and transient ischemic attack: case report.

作者信息

de Lima Michelle Franco Macedo, Varano Nathália, de Almeida Neto Omar Pereira, Mendes David de Souza

机构信息

Cardiology Nursing Practitioner Fellowship, Federal University of Uberlandia Uberlândia 38400-142, MG, Brazil.

Cardiovascular Science, Department of Medicine, Federal University of Uberlandia Uberlândia 38400-902, MG, Brazil.

出版信息

Am J Cardiovasc Dis. 2021 Aug 15;11(4):494-498. eCollection 2021.

Abstract

Cardiac tumors are rare and myxomas are the most prevalent among them. Although it presents benign histology, they may be the cause of severe consequences due to intracardiac location. Nonspecific manifestations may hinder the diagnosis, which can lead to complications, such as changes in cardiac dynamics, thromboembolic events and death. This paper presents a case report of a patient in the emergency department of a high complexity hospital in Minas Gerais State, Brazil, with a clinical history of angina and 7 previous Transient Ischemic Attack (TIA), besides aphasia, right hemiparesis, dysarthria, and mouth deviation. Submitted to transesophageal echocardiography, she was diagnosed with left atrial myxoma. For the treatment of myxoma, a surgical approach was used to resect the myxoma in the left atrium. The standard surgical approach was through a median sternotomy. Cardiopulmonary bypass (CPB) with aortic and bicaval cannulation and moderate hypothermia was used. Myocardial protection was achieved by cold antegrade blood cardioplegia. The patient had notable characteristics for the diagnosis, especially the previous occurrence of seven episodes of TIA. The importance of correct clinical investigation (anamnesis, general and specific physical examination and imaging tests) is notable and a fundamental tool for the diagnosis and early treatment of neoplasia, providing good clinical outcomes.

摘要

心脏肿瘤较为罕见,其中黏液瘤最为常见。尽管其组织学表现为良性,但由于位于心腔内,可能导致严重后果。非特异性表现可能会妨碍诊断,进而引发并发症,如心脏动力学改变、血栓栓塞事件及死亡。本文报告了巴西米纳斯吉拉斯州一家高复杂性医院急诊科的一名患者,该患者有心绞痛病史及7次既往短暂性脑缺血发作(TIA),此外还有失语、右侧偏瘫、构音障碍和口角歪斜。经食管超声心动图检查后,她被诊断为左心房黏液瘤。对于黏液瘤的治疗,采用手术方法切除左心房黏液瘤。标准手术入路是通过正中胸骨切开术。使用主动脉和双腔静脉插管及中度低温的体外循环(CPB)。通过冷灌注顺行性心脏停搏液实现心肌保护。该患者在诊断方面有显著特征,尤其是既往发生过7次TIA。正确的临床检查(病史采集、一般和专科体格检查及影像学检查)非常重要,是肿瘤诊断和早期治疗的基本工具,可带来良好的临床结果。

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本文引用的文献

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J Cardiol Cases. 2017 Mar 6;15(4):132-135. doi: 10.1016/j.jccase.2016.12.005. eCollection 2017 Apr.
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Clinical presentation and treatment of cardiac myxoma in 153 patients.153例心脏黏液瘤的临床表现与治疗
Medicine (Baltimore). 2018 Sep;97(37):e12397. doi: 10.1097/MD.0000000000012397.
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Atrial myxoma related with ischemic cerebrovascular event.心房黏液瘤与缺血性脑血管事件相关。
Med Clin (Barc). 2018 Dec 21;151(12):e69-e70. doi: 10.1016/j.medcli.2018.04.004. Epub 2018 May 24.
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CARE guidelines for case reports: explanation and elaboration document.病例报告的CARE指南:解释与阐述文件。
J Clin Epidemiol. 2017 Sep;89:218-235. doi: 10.1016/j.jclinepi.2017.04.026. Epub 2017 May 18.

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