Pavie A, Escande G, Cham B, Baehrel B, Barra J, Villemot J P, Gandjbakhch I, Cabrol C
Arch Mal Coeur Vaiss. 1981 Mar;74(3):265-72.
The authors report 3 cases of right atrial myxoma and review 88 other cases in the literature managed by surgery. The first personal case, in a 74 year old patient, illustrate the dramatic consequences of tumour engagement in the tricuspid orifice, in this instance cardiac arrest during catheterisation justifying emergency surgery. The second case exemplifies the diagnostic value of echocardiography: the correction of an erroneous diagnosis of pericarditis. The third case shows that some forms may be totally asymptomatic, the tumor being diagnosed on clinical examination and confirmed by echocardiography. In their review of the literature, the low overall incidence of primary cardiac tumours, of which myxoma is the most common, is emphasised. A right atrial localisation is found in only 25% cases. 88 surgical reports have been published since Bahnam's original attempt at surgical cure under cardiopulmonary bypass. Myxoma may occur at any age but it usually presents between the ages of 30 and 60. Some familial forms have been reported. The presenting symptoms are protean but usually point to an obstacle in the right heart chambers. They may be summarized as follows: 1. Isolated right ventricular failure without left heart disease may be observed in large tumours (reported in 50% of cases). 2. Simulating pericarditis (25% of cases) with a low grade pyrexia (25% of cases). 3. Paroxysmas of cardio respiratory distress of variable severity (a few cases). Clinical examination, chest x-ray and ECG are not diagnostic but do show non-specific changes which are of value in drawing attention to the heart and leading to echocardiography. This confirms the diagnosis by showing abnormal mobile echos in the right atrium prolapsing into the right ventricle in diastole. Angiography serves only to confirm these appearances. Surgery is the treatment of choice, and preferably with the shortest possible delay. It offers definitive cure at a minimal risk to the patient.
作者报告了3例右心房黏液瘤病例，并回顾了文献中另外88例接受手术治疗的病例。第一例个人病例为一名74岁患者，说明了肿瘤嵌顿于三尖瓣口的严重后果，在该病例中，导管插入术期间心脏骤停，这证明了急诊手术的合理性。第二例病例例证了超声心动图的诊断价值：纠正了心包炎的误诊。第三例病例表明，某些类型可能完全无症状，肿瘤通过临床检查诊断，并经超声心动图证实。在他们对文献的回顾中，强调了原发性心脏肿瘤的总体发病率较低，其中黏液瘤最为常见。仅25%的病例发现肿瘤位于右心房。自巴纳姆最初尝试在体外循环下进行手术治愈以来，已发表了88份手术报告。黏液瘤可发生于任何年龄，但通常出现在30至60岁之间。已报告了一些家族性类型。其表现症状多种多样，但通常提示右心腔存在梗阻。可总结如下：1. 大肿瘤患者可能出现孤立性右心室衰竭而无左心疾病（50%的病例有报告）。2. 模拟心包炎（25%的病例），伴有低热（25%的病例）。3. 不同严重程度的阵发性心肺窘迫（少数病例）。临床检查、胸部X线和心电图无诊断价值，但确实显示出非特异性变化，这些变化有助于引起对心脏的关注并进行超声心动图检查。超声心动图通过显示舒张期右心房内异常的可移动回声脱垂至右心室来确诊。血管造影仅用于证实这些表现。手术是首选治疗方法，最好尽早进行。手术能以最小的患者风险实现根治。
