DIAGNOSIS AND TREATMENT OF CARDIAC MYXOMA
Rubrics: CARDIOLOGY
Authors:
1.
Irkutsk State Medical Academy of Postgraduate Education
(Department of Cardiovascular Surgery and Clinical Angiology, Head)
Irkutsk, Irkutsk region, Russian Federation
Irkutsk, Irkutsk region, Russian Federation
2.
Irkutsk Regional Clinical Hospital
(Cardiac Surgery Department N 1, Cardiovascular Surgeon)
from 01.01.1920 until now
Irkutsk, Irkutsk region, Russian Federation
from 01.01.1920 until now
Irkutsk, Irkutsk region, Russian Federation
3.
Irkutsk State Medical Academy of Postgraduate Education
(Department of Cardiovascular Surgery and Clinical Angiology, Professor)
Irkutsk, Irkutsk region, Russian Federation
Irkutsk, Irkutsk region, Russian Federation
4.
Irkutsk Regional Clinical Hospital
(Cardiac Surgery Department N 1, Cardiovascular Surgeon)
from 26.12.1945 until now
Irkutsk, Irkutsk region, Russian Federation
from 26.12.1945 until now
Irkutsk, Irkutsk region, Russian Federation
5.
Irkutsk Regional Clinical Hospital
(Cardiac Surgery Department N 1, Cardiovascular Surgeon)
from 31.12.1939 until now
Irkutsk, Irkutsk region, Russian Federation
from 31.12.1939 until now
Irkutsk, Irkutsk region, Russian Federation
6.
Irkutsk State Medical Academy of Postgraduate Education
(Department of Anesthesiology and Intensive Care Medicine, Professor)
from 22.12.1941 until now
Irkutsk, Irkutsk region, Russian Federation
from 22.12.1941 until now
Irkutsk, Irkutsk region, Russian Federation
Type:
Article
Pages:
from 21
to 26
Status:
Published
Received:
14.11.2017
Accepted:
30.11.2017
Published:
30.11.2017
Subject area:
UDK 61 Медицина. Охрана здоровья
Language:
Russian
Keywords:
opuhol' serdca, miksoma serdca, lechenie miksom
Abstract (English):
Opuholi serdca, otnosyaschiesya k chrezvychayno redkoy patologii s polimorfnoy kartinoy, v techenie dlitel'nogo vremeni vyyavlyali preimuschestvenno na autopsiyah i lish' sluchayno – pri kardiohirurgicheskih operaciyah. Pervichnye novoobrazovaniya serdca vyyavlyayutsya v 0,002–0,05 sluchaya vseh vskrytiy, prichem 75 % iz nih – dobrokachestvennye opuholi. Miksoma serdca – naibolee chasto vstrechayuschayasya dobrokachestvennaya opuhol' serdca. Miksoma mozhet nahodit'sya v lyuboy kamere serdca, no naibolee chasto lokalizuetsya v levom predserdii. Miksomy, imeyuschie nozhku, prolabiruyut cherez mitral'nyy klapan, zatrudnyaya oporozhnenie levogo predserdiya i zapolnenie zheludochka vo vremya diastoly. Makroskopicheski miksomy mogut imet' slizevidnuyu, tverduyu, dol'chatuyu ili ryhluyu strukturu. Neoformlennye ryhlye miksomy predstavlyayut naibol'shuyu opasnost' v plane razvitiya sistemnoy embolii. Miksomy mogut voznikat' takzhe v polosti zheludochka ili raspolagat'sya v neskol'kih kamerah serdca. Bol'shinstvo iz nih raspolagayutsya na nozhke, predstavlyayuschey soboy fibrozno-sosudistyy stebel', i imeyut diametr 4–8 sm. V 93 % nablyudeniy miksomy predstavlyayut soboy odinochnye opuholi, odnako oni mogut byt' biatrial'nymi, a takzhe mogut razvivat'sya v neskol'kih kamerah serdca, yavlyayas', takim obrazom, pervichno-mnozhestvennymi opuholyami. Simptomy shiroko var'iruyut i zavisyat ot razmerov i lokalizacii opuholi. V nastoyaschee vremya v svyazi s uluchsheniem kachestva diagnostiki chastota vyyavlyaemosti novoobrazovaniy serdca ezhegodno rastet i, po dannym razlichnyh avtorov, na segodnyashniy den' sostavlyaet ot 0,5 do 2,3 sluchaya v god na 1 mln naseleniya. Proanalizirovana gruppa iz 70 pacientov v vozraste ot 19 do 77 let s morfologicheski verificirovannymi miksomami serdca. Edinstvennyy metod lecheniya bol'nyh s miksomami serdca – udalenie opuholi v usloviyah iskusstvennogo krovoobrascheniya. V dannoy stat'e opisan klinicheskiy sluchay, v kotorom miksoma serdca byla bol'shih razmerov i zanimala prakticheski vsyu polost' levogo predserdiya, sozdavaya obstrukciyu mitral'nogo klapana pri znachitel'nyh klinicheskih proyavleniyah. Planovoe ehokardiograficheskoe issledovanie pozvolilo svoevremenno postavit' diagnoz i provesti neobhodimoe lechenie.
Opuholi serdca, otnosyaschiesya k chrezvychayno redkoy patologii s polimorfnoy kartinoy, v techenie dlitel'nogo vremeni vyyavlyali preimuschestvenno na autopsiyah i lish' sluchayno – pri kardiohirurgicheskih operaciyah. Pervichnye novoobrazovaniya serdca vyyavlyayutsya v 0,002–0,05 sluchaya vseh vskrytiy, prichem 75 % iz nih – dobrokachestvennye opuholi. Miksoma serdca – naibolee chasto vstrechayuschayasya dobrokachestvennaya opuhol' serdca. Miksoma mozhet nahodit'sya v lyuboy kamere serdca, no naibolee chasto lokalizuetsya v levom predserdii. Miksomy, imeyuschie nozhku, prolabiruyut cherez mitral'nyy klapan, zatrudnyaya oporozhnenie levogo predserdiya i zapolnenie zheludochka vo vremya diastoly. Makroskopicheski miksomy mogut imet' slizevidnuyu, tverduyu, dol'chatuyu ili ryhluyu strukturu. Neoformlennye ryhlye miksomy predstavlyayut naibol'shuyu opasnost' v plane razvitiya sistemnoy embolii. Miksomy mogut voznikat' takzhe v polosti zheludochka ili raspolagat'sya v neskol'kih kamerah serdca. Bol'shinstvo iz nih raspolagayutsya na nozhke, predstavlyayuschey soboy fibrozno-sosudistyy stebel', i imeyut diametr 4–8 sm. V 93 % nablyudeniy miksomy predstavlyayut soboy odinochnye opuholi, odnako oni mogut byt' biatrial'nymi, a takzhe mogut razvivat'sya v neskol'kih kamerah serdca, yavlyayas', takim obrazom, pervichno-mnozhestvennymi opuholyami. Simptomy shiroko var'iruyut i zavisyat ot razmerov i lokalizacii opuholi. V nastoyaschee vremya v svyazi s uluchsheniem kachestva diagnostiki chastota vyyavlyaemosti novoobrazovaniy serdca ezhegodno rastet i, po dannym razlichnyh avtorov, na segodnyashniy den' sostavlyaet ot 0,5 do 2,3 sluchaya v god na 1 mln naseleniya. Proanalizirovana gruppa iz 70 pacientov v vozraste ot 19 do 77 let s morfologicheski verificirovannymi miksomami serdca. Edinstvennyy metod lecheniya bol'nyh s miksomami serdca – udalenie opuholi v usloviyah iskusstvennogo krovoobrascheniya. V dannoy stat'e opisan klinicheskiy sluchay, v kotorom miksoma serdca byla bol'shih razmerov i zanimala prakticheski vsyu polost' levogo predserdiya, sozdavaya obstrukciyu mitral'nogo klapana pri znachitel'nyh klinicheskih proyavleniyah. Planovoe ehokardiograficheskoe issledovanie pozvolilo svoevremenno postavit' diagnoz i provesti neobhodimoe lechenie.
Keywords:
opuhol' serdca, miksoma serdca, lechenie miksom
opuhol' serdca, miksoma serdca, lechenie miksom
1. Diagnostika i lechenie miksom serdca
