Grinda J M, Couetil J P, Chauvaud S, D'Attellis N, Berrebi A, Fabiani J N, Deloche A, Carpentier A
Department of Cardiovascular Surgery of Broussais Hospital [1], Paris, France.
J Thorac Cardiovasc Surg. 1999 Jan;117(1):106-10. doi: 10.1016/s0022-5223(99)70474-5.
We have reviewed the case histories of 4 patients who underwent operations between September 1994 and November 1997 at Broussais Hospital for cardiac valvular papillary fibroelastoma.
Diagnosis was strongly suggested by echocardiography. Tumor locations were mitral (1), tricuspid (1), and aortic (2). Indications for operation were previous stroke for the mitral tumor, prophylaxis for the tricuspid tumor, syncopal episodes for the first aortic tumor, and transient ischemic attack and mesenteric ischemia for the second aortic tumor.
Surgical excision with a conservative, valve-sparing approach was performed in all cases. For the first aortic tumor, aortic valve reconstruction was achieved with part of a cryopreserved aortic homograft cusp. Intraoperative transesophageal echocardiography showed no evidence of valvular regurgitation after excision in all cases. All patients had uneventful postoperative recoveries. No evidence of regurgitation or recurrence was seen on echocardiography at follow-up.
Despite their histologically benign aspect, cardiac papillary fibroelastomas should be excised because of potential embolic complications. A conservative, valve-sparing approach is recommended, however, because of the absence of recurrence after total excision.
我们回顾了1994年9月至1997年11月间在布鲁赛医院接受心脏瓣膜乳头状纤维弹性瘤手术的4例患者的病历。
超声心动图强烈提示诊断。肿瘤位置分别为二尖瓣（1例）、三尖瓣（1例）和主动脉瓣（2例）。二尖瓣肿瘤的手术指征为既往中风，三尖瓣肿瘤为预防，首例主动脉瓣肿瘤为晕厥发作，第二例主动脉瓣肿瘤为短暂性脑缺血发作和肠系膜缺血。
所有病例均采用保留瓣膜的保守手术切除。对于首例主动脉瓣肿瘤，用部分冷冻保存的主动脉同种异体瓣膜尖重建主动脉瓣。术中经食管超声心动图显示，所有病例切除后均无瓣膜反流迹象。所有患者术后恢复顺利。随访超声心动图未见反流或复发迹象。
尽管心脏乳头状纤维弹性瘤组织学表现为良性，但由于潜在的栓塞并发症，仍应予以切除。然而，由于完全切除后无复发，建议采用保留瓣膜的保守方法。
