Settembrini Alberto M, Foresti Leonardo, Verlato Paolo, Buongiovanni Gianluca, Bissacco Daniele, Lomazzi Chiara, Maggioni Marco, Trimarchi Santi
Department of Cardio Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
EJVES Vasc Forum. 2024 Jul 8;62:35-40. doi: 10.1016/j.ejvsvf.2024.07.036. eCollection 2024.
Cardiac myxomas (CMs) are the most common primary cardiac tumour in adults. They are a rare cause of peripheral embolisation and may present as acute lower limb ischaemia (ALI). A scoping review was undertaken and a case of ALI due to CM embolisation is presented in this paper.
MEDLINE, Scopus, and Embase were systematically searched for studies reporting data on ALI as a presentation of CM embolisation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) was followed.
A healthy 26 year old female presented to the emergency department with bilateral ALI. Urgent bilateral aorto-iliac embolectomy and distal embolectomy of the left femoropopliteal axis were performed. The retrieved embolic material exhibited a yellowish appearance and jelly like consistency, and histological analysis provided a diagnosis of a myxomatous embolus. Transoesophageal echocardiography confirmed the left atrial origin of a myxomatous tumour, but the residual mass was considered too small for further excision. At a two year clinical follow up, the patient was alive and well without recurrence. Between 1989 and 2023, 59 patients with ALI due to CM embolisation were identified in the literature. An in hospital mortality rate of 12.1% ( = 7) was reported, while the in hospital complication and re-intervention rates were 34.5% ( = 20) and 27.6% ( = 16), respectively. No post-discharge deaths, complications, or re-interventions were reported; fasciotomies were the most reported ( = 10). Post-discharge follow up was reported in 22 (37.3%) patients. Mean follow up was 18.0 ± 18.8 months (range 1-120), and 86.4% of patients ( = 19) were alive and well at last follow up.
This review and the associated case report underline that CM embolisation should be considered in healthy young patients presenting with cryptogenic ALI. Early transoesophageal echocardiography and histological analysis of the retrieved embolus are recommended to minimise misdiagnosis in these populations.
心脏黏液瘤（CMs）是成人最常见的原发性心脏肿瘤。它们是外周栓塞的罕见原因，可能表现为急性下肢缺血（ALI）。本文进行了一项范围综述，并报告了一例因CM栓塞导致ALI的病例。
系统检索MEDLINE、Scopus和Embase，查找报告ALI作为CM栓塞表现的数据的研究。遵循系统评价和Meta分析扩展的范围综述的首选报告项目（PRISMA-ScR）。
一名26岁健康女性因双侧ALI就诊于急诊科。紧急进行了双侧主动脉-髂动脉取栓术和左股腘动脉轴远端取栓术。取出的栓子呈淡黄色，质地似果冻，组织学分析诊断为黏液瘤栓子。经食管超声心动图证实黏液瘤起源于左心房，但残留肿块过小，无法进一步切除。在两年的临床随访中，患者存活且情况良好，无复发。1989年至2023年期间，文献中确定了59例因CM栓塞导致ALI的患者。报告的住院死亡率为12.1%（n = 7），而住院并发症和再次干预率分别为34.5%（n = 20）和27.6%（n = 16）。未报告出院后死亡、并发症或再次干预情况；筋膜切开术报告最多（n = 10）。22例（37.3%）患者进行了出院后随访。平均随访时间为18.0±18.8个月（范围1 - 120个月），最后一次随访时86.4%的患者（n = 19）存活且情况良好。
本综述及相关病例报告强调，对于出现不明原因ALI的健康年轻患者，应考虑CM栓塞。建议早期进行经食管超声心动图检查及对取出栓子进行组织学分析，以尽量减少这些人群的误诊。
