Fukunaga Naoto, Wakami Tatsuto, Shimoji Akio, Maeda Toshi, Mori Otohime, Yoshizawa Kosuke, Okada Tatsuji, Tamura Nobushige
Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.
Kyobu Geka. 2022 Mar;75(3):217-220.
A 48-year-old female patient was transferred with dysarthria and left-sided hemiplegia. Contrast-enhanced computed tomography revealed occlusion of the first branch of the right middle cerebral artery, for which an emergency thrombectomy was successfully performed within 2 hours of patient's initial symptoms. Postoperatively, transthoracic echocardiography revealed a massive mobile left atrial mass, measuring approximately 65×30 mm, a part of which moved in and out of the mitral valve without significant mitral regurgitation. Embolisms to the kidneys and the spleen were demonstrated. Another emergency cardiac surgery was performed, 4 hours after the thrombectomy, to resect the mass from the fossa oval with the atrial septum;the defect was closed using autologous pericardium. The histopathological findings of the specimen were consistent with a myxoma. The patient completely recovered and was discharged when ambulatory. We have discussed the importance of the timing of surgical intervention in the context of patients undergoing cardiac surgery after a cerebral embolism.
一名48岁女性患者因构音障碍和左侧偏瘫被转诊。增强计算机断层扫描显示右大脑中动脉第一分支闭塞,在患者出现初始症状后2小时内成功进行了紧急血栓切除术。术后,经胸超声心动图显示左心房有一个巨大的活动肿物,大小约为65×30mm,部分肿物进出二尖瓣,无明显二尖瓣反流。证实有肾和脾栓塞。在血栓切除术后4小时进行了另一台紧急心脏手术,从卵圆窝和房间隔切除肿物;用自体心包封闭缺损。标本的组织病理学检查结果与黏液瘤一致。患者完全康复,能行走后出院。我们讨论了在脑栓塞后接受心脏手术的患者中手术干预时机的重要性。