Okuri H, Shimizu M, Yokoyama K, Kawada H, Irisawa A, Kikawada R
Department of Internal Medicine, Kitasato University School of Medicine.
Kokyu To Junkan. 1993 Apr;41(4):397-401.
There are some reports concerning operations of right atrial myxoma. But precise effect on systemic hemodynamics before and after operation of right atrial myxoma has not been reported. We studied hemodynamics of a 54 year-old male with right atrial myxoma before and after removal of myxoma by M-mode and two-dimensional echocardiography. He was admitted to our hospital because of dyspnea on effort and orthostatic dizziness. On two-dimensional echocardiography the apical four chamber view showed an abnormal huge mass echo with cystic change (6.9 x 4.4 cm) moving between the right atrium and the orifice of tricuspid valve. From this finding emergent operation was undertaken with the possible diagnosis of right atrial myxoma, and the mass was found to be a benign myxoma histopathologically originating from the right side of atrial septum. Left ventricular dimensions (Dd, Ds) and the dimension of left atrial chamber were enlarged after the operation by M-mode echocardiography. Among the left ventricular inflow parameters, rapid filling peak velocity (E) increased with no change in presystolic peak velocity (A) and A/E improved from 1.63 to 0.95. This improvement of left ventricular diastolic function was supposed to be induced through the increased preload. After the operation his manifestations of dyspnea and dizziness have disappeared. It should be emphasized that an increase in preload after the removal of right atrial myxoma is very important to keep left ventricular diastolic and systolic function.
有一些关于右心房黏液瘤手术的报道。但右心房黏液瘤手术前后对体循环血流动力学的确切影响尚未见报道。我们通过M型和二维超声心动图研究了一名54岁右心房黏液瘤男性患者在黏液瘤切除前后的血流动力学。他因劳力性呼吸困难和体位性头晕入院。二维超声心动图的心尖四腔视图显示一个异常巨大的有囊性改变的肿块回声（6.9×4.4厘米）在右心房和三尖瓣口之间移动。根据这一发现，考虑可能诊断为右心房黏液瘤而紧急进行了手术，病理组织学检查发现该肿块是起源于房间隔右侧的良性黏液瘤。术后M型超声心动图显示左心室大小（Dd、Ds）和左心房腔大小增大。在左心室流入参数中，快速充盈峰值速度（E）增加，而收缩前期峰值速度（A）无变化，A/E从1.63改善至0.95。左心室舒张功能的这种改善被认为是通过增加前负荷引起的。术后他的呼吸困难和头晕症状消失。应该强调的是，右心房黏液瘤切除后前负荷的增加对于维持左心室舒张和收缩功能非常重要。
