St John Sutton M G, Mercier L A, Giuliani E R, Lie J T
Mayo Clin Proc. 1980 Jun;55(6):371-6.
We have reviewed the Mayo Clinic experience in the diagnosis and management of 40 cases of atrial myxoma seen over a 20-year period, 1957 to 1977. The diagnosis of atrial myxoma was seldom made clinically on the basis of history, physical examination, chest roentgenogram, or electrocardiogrammthere was no reduction in the time interval from onset of symptoms to operation between patients seen in the period 1957-1967 and those seen in 1968-1977. Although myxomas are rare, they should be considered in the differential diagnosis of patients with suspected mitral valve disease and congestive heart failure or constitutional disturbances who are in sinus rhythm. The greater number of patients diagnosed preoperatively in the second 10-year period, 1968-1977, reflects the introduction of echocardiography as a noninvasive diagnostic procedure. Echocardiography should be performed on all young patients with embolic disease and on those in whom the diagnosis of myxoma needs to be ruled out before exploratory or definitive surgery is undertaken so that unnecessary and potentially serious complications can be avoided. Surgical excision of the myxoma can be performed with low mortality (1 death occurred in 37 cases or 2.7%), and it provides excellent and sustained symptomatic relief. The recurrence rate is low (5.4%), but long-term follow-up and serial echocardiography are advisable.
我们回顾了梅奥诊所1957年至1977年20年间对40例心房黏液瘤的诊断和治疗经验。心房黏液瘤很少能根据病史、体格检查、胸部X线片或心电图在临床上作出诊断——1957 - 1967年期间就诊的患者与1968 - 1977年期间就诊的患者相比，从症状出现到手术的时间间隔并无缩短。尽管黏液瘤罕见，但对于窦性心律且疑似二尖瓣疾病、充血性心力衰竭或全身性紊乱的患者，鉴别诊断时应考虑到黏液瘤。1968 - 1977年第二个十年期间术前诊断出的患者数量更多，这反映了超声心动图作为一种非侵入性诊断方法的引入。对于所有患有栓塞性疾病的年轻患者以及那些在进行探索性或确定性手术前需要排除黏液瘤诊断的患者，都应进行超声心动图检查，以便避免不必要的且可能严重的并发症。黏液瘤手术切除的死亡率较低（37例中有1例死亡，即2.7%），且能提供极佳且持久的症状缓解。复发率较低（5.4%），但建议进行长期随访和系列超声心动图检查。
