Tsukamoto S, Shiono M, Orime Y, Hata H, Yagi S, Kimura S, Hata M, Sezai A, Sezai Y
Second Department of Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi Itabashi-ku Tokyo, 173-0032, Japan.
Ann Thorac Cardiovasc Surg. 1998 Jun;4(3):133-7.
We report a case of a 49 year-old Japanese woman with a left atrial myxoma complicated by an atrial septal defect diagnosed intraoperatively, which was classified as in secundum defect and was 28x110 mm in diameter. The tumor, which was attached by a pedicle to the posterior wall of the left atrium near the posterior commissure of the mitral valve, was removed together with a small portion of the left atrial wall. The postoperative course was uneventful. The pathologic findings were consistent with the diagnosis of myxoma. Since the defect was functionally canceled by the myxoma, the diagnosis of an atrial septal defect was not confirmed preoperatively even by color Doppler echocardiography and cardiac catheterization. Tumor embolization is one of the critical complications of myxoma. Fortunately, she didn't suffer from either systemic or pulmonary emboli. During surgery of myxoma with atrial septal defect, careful manipulation is needed, especially at caval cannulation so as not to damage the tumor directly. In the cases with atrial septal defect or patent foramen ovale, myxomas are generally situated on the interatrial septum. However, in this case the tumor was located on the posterior wall of the left atrium.
我们报告一例49岁的日本女性，患有左心房黏液瘤并伴有术中诊断出的房间隔缺损，该缺损为继发孔型，直径为28×110毫米。肿瘤通过蒂附着于二尖瓣后联合附近的左心房后壁，连同一小部分左心房壁一并切除。术后病程顺利。病理结果与黏液瘤的诊断相符。由于缺损在功能上被黏液瘤抵消，术前即使通过彩色多普勒超声心动图和心导管检查也未确诊房间隔缺损。肿瘤栓塞是黏液瘤的关键并发症之一。幸运的是，她未发生体循环或肺栓塞。在伴有房间隔缺损的黏液瘤手术中，需要仔细操作，尤其是在腔静脉插管时，以免直接损伤肿瘤。在有房间隔缺损或卵圆孔未闭的病例中，黏液瘤通常位于房间隔上。然而，在本病例中，肿瘤位于左心房后壁。
