Qi Wei, Yu Xiao-Lu, Yang Da-Xuan, Hu Xu-Kai, Chen Jun-Ping, Yao Yun-Tai
Department of Anesthesiology, Ningbo No.2 Hospital, Zhejiang, China.
Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Front Cardiovasc Med. 2023 Apr 27;10:1126822. doi: 10.3389/fcvm.2023.1126822. eCollection 2023.
Myxomas are the most common primary cardiac tumors. Intracardiac myxomas, although benign, could cause serious consequences such as tricuspid or mitral valve obstruction, hemodynamic collapse, and acute heart failure, which pose challenges during anesthetic management. The current study was designed to summarize the anesthetic management of patients undergoing cardiac myxoma resection.
This study was performed retrospectively from the perioperative period of patients who underwent myxoma resection. Patients were divided into two groups according to whether the myxoma prolapsed into the ventricle (group O) or not (group N) to evaluate the impact of tricuspid or mitral valve with obstruction.
110 patients, aged 17-78 years, undergoing cardiac myxoma resection between January 2019 and December 2021 were collected, and their perioperative characteristics were recorded. In the preoperative evaluation, common clinical symptoms included dyspnea and palpitation, whereas embolic events occurred in 8 patients, including 5 (4.5%) cerebral thromboembolic events, 2 (1.8%) femoral artery, and 1 (0.9%) obstructive coronary artery. According to the echocardiography, left atrial myxoma was detected in 104 (94.5%) patients, the average dimension of myxoma was 4.03 cm ± 1.52 cm in the largest diameter, and 48 patients were divided into group O. During intraoperative anesthetic management, hemodynamic instability occurred in 38 (34.5%) patients after anesthesia induction. More patients in group O had hemodynamic instability (47.9% vs. 24.2%, = 0.009) than in group N. The mean postoperative length of stay in the hospital was 10.64 ± 3.01 days, and most of the patients made an uneventful postoperative recovery.
Anesthetic management for myxoma resection can be composed by assessing the myxoma, particularly the echocardiography evaluation and preventing cardiovascular instability. Typically, tricuspid or mitral valve with obstruction is a premier ingredient in anesthetic management.
黏液瘤是最常见的原发性心脏肿瘤。心内黏液瘤虽然是良性的，但可导致严重后果，如三尖瓣或二尖瓣梗阻、血流动力学崩溃和急性心力衰竭，这给麻醉管理带来挑战。本研究旨在总结心脏黏液瘤切除术患者的麻醉管理。
本研究对接受黏液瘤切除术患者的围手术期进行回顾性研究。根据黏液瘤是否脱垂入心室（O组）将患者分为两组，以评估三尖瓣或二尖瓣梗阻的影响。
收集了2019年1月至2021年12月期间110例年龄在17 - 78岁之间接受心脏黏液瘤切除术的患者，并记录其围手术期特征。术前评估中，常见临床症状包括呼吸困难和心悸，8例患者发生栓塞事件，其中5例（4.5%）为脑栓塞事件，2例（1.8%）为股动脉栓塞，1例（0.9%）为冠状动脉梗阻。根据超声心动图检查，104例（94.5%）患者检测到左心房黏液瘤，黏液瘤最大直径平均为4.03 cm±1.52 cm，48例患者分为O组。术中麻醉管理期间，38例（34.5%）患者麻醉诱导后出现血流动力学不稳定。O组血流动力学不稳定的患者比N组更多（47.9%对24.2%，P = 0.009）。术后平均住院时间为10.64±3.01天，大多数患者术后恢复顺利。
黏液瘤切除术的麻醉管理可通过评估黏液瘤，特别是超声心动图评估并预防心血管不稳定来进行。通常，三尖瓣或二尖瓣梗阻是麻醉管理的首要因素。
