二尖瓣内肿块狭窄:1例报告及文献复习

Noël Mahoungou-Mackonia, M. Khalil, Karim Fatiha, I. Nouamou, S. Arous, G. Benouna, A. Drighil, L. Azzouzi, R. Habbal
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摘要

导读:良性心内肿瘤是最常见的,占原发性肿瘤的5%,占心内肿瘤的90%。黏液瘤是主要的良性肿瘤,很少局限于二尖瓣,约占1-5%,伴有严重的症状和大量并发症。目的是报告一个罕见和严重的二尖瓣粘液瘤导致严重阻塞的瓣膜口。案例陈述:65岁摩洛哥女性,无职业,糖尿病患者,表现为进行性呼吸困难,经胸超声心动图(TTE)、经食管超声心动图(TEE)、心脏磁共振成像(MRI)、脑-喉-腹-盆腔正电子发射断层扫描(pet)示菜花状肿块嵌埋在小二尖瓣内,经解剖病理检查证实为粘液瘤。乳房肿瘤切除合并二尖瓣成形术合并冠状动脉搭桥手术治疗三截体病变。这一演变的特点是临床和超声状态的改善。讨论:黏液瘤是女性在30岁至60岁之间遇到的第一个良性肿瘤,其诊断可通过TTE, TEE或更多,计算机断层扫描(CT扫描)甚至心脏MRI引起,该MRI明确了软性部分的可视化以及黏液瘤的所有内部细节,其确认是在手术室的组织病理学分析中进行的。结论:二尖瓣成形术治疗的基础是肿瘤的完全切除。
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Stenosing Intracardiac Mass of the Mitral Valve: A Case Report and Review of the Literature
Introduction: Benign intracardiac tumours are the most common of the 5% of primary tumours and account for 90% of intracardiac tumours. Myxoma, which is the main benign tumour, rarely localizes to the mitral valve, in the order of 1-5%, associated with severe symptoms and enormous complications. The objective is to report a rare and severe case of mitral valve myxoma resulting in severe obstruction of the valve orifice. Presentation of Case: A 65-year-old Moroccan woman, without profession, the diabetic patient presented with progressive dyspnoea, in whom transthoracic echocardiography (TTE) completed by transesophageal echocardiography (TEE), a cardiac magnetic resonance imaging (MRI), a cerebro-throracoabdominopelvic Positron emission tomography-scan (PET-scan) showed a cauliflower-shaped mass embedded in the small mitral valve, evoking the diagnosis of myxoma, confirmed by the anatomopathological examination. A lumpectomy with mitral valve plasty was performed in association with coronary artery bypass surgery for a tri truncal lesion. The evolution was marked by an improvement in the clinical and echographic state. Discussion: Myxoma is the first benign tumour encountered in women between the 3rd and 6th decade, whose diagnosis is evoked by a TTE, better by a TEE or more, by a computed tomography (CT scan) or even a cardiac MRI which specifies the visualization of the soft parts with all the internal details of the myxoma, whose confirmation is carried out on the histopathological analysis of the operating room. Conclusion: The management was based on complete resection of the tumor associated with mitral valve plasty.
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