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原发性心脏肿瘤的外科治疗

目的 总结原发性心脏肿瘤的外科治疗经验，以提高手术疗效。 方法 回顾性分析1980年6月至2008年12月中国医科大学附属第一医院收治的263例原发性心脏肿瘤患者的临床资料，其中男90例，女173例；年龄10～79岁（41±13岁）。良性肿瘤241例，其中良性粘液瘤240例，纤维瘤1例；恶性肿瘤22例，其中恶性粘液瘤7例，恶性间皮瘤4例，血管肉瘤5例，横纹肌肉瘤1例，肺动脉内膜肉瘤1例，平滑肌肉瘤1例，炎症性恶性纤维组织细胞瘤1例，恶性淋巴瘤1例，滑膜肉瘤1例。手术完整摘除肿瘤252例（恶性肿瘤11例），局部切除肿瘤5例（均为恶性肿瘤），开胸探查取病理活组织检查6例（均为恶性肿瘤）。同期行冠状动脉旁路移植术（CABG）5例，二尖瓣置换术5例，二尖瓣成形术4例，三尖瓣成形术9例，三尖瓣生物瓣置换术1例，主动脉根部及肺动脉成形术1例，肺动脉瓣置换术1例，肺动脉主干及左右肺动脉人工血管加肺动脉瓣置换术1例，肺动脉切开取栓术1例，经股动脉取瘤栓术5例。 结果 围术期死亡7例（良性粘液瘤6例、恶性粘液瘤1例），其中术中不能停体外循环2例，术后发生低心排血量、心室颤动3例，呼吸、循环衰竭1例，大面积脑出血1例；其余患者无并发症发生。随访247例（良性肿瘤229例，恶性肿瘤18例），随访时间3个月～28年，失访9例（良性肿瘤6例、恶性肿瘤3例）。随访期间良性粘液瘤复发4例，均再次手术治疗；良性肿瘤患者死亡13例（心源性猝死6例、脑卒中2例、肺癌1例、不明原因4例），其余216例均生存。随访期间恶性肿瘤患者死亡15例，术后生存时间为1～4年，死于肿瘤复发或转移11例，心力衰竭和恶病质各2例。 结论 原发性心脏肿瘤一经确诊应尽早手术治疗，良性肿瘤手术效果好，恶性肿瘤术中应尽量切除肿瘤。

右心房粘液瘤累及三尖瓣一例

原发性恶性心脏肿瘤一例

左心房恶性胸腺小细胞癌一例

心脏粘液瘤的诊断与外科治疗

目的 总结心脏粘液瘤的外科治疗经验。 方法 回顾性分析1997年6月～2006年6月我院收治的113例心脏粘液瘤患者的临床资料，其中左心房粘液瘤98例,左心室粘液瘤2例,右心房粘液瘤8例,右心室粘液瘤4例,双心房粘液瘤1例。所有患者均在中度低温体外循环下行粘液瘤摘除术,同期行二尖瓣机械瓣置换术2例,二尖瓣成形术3例,三尖瓣成形术7例,腹主动脉取栓术1例。 结果 本组围术期死亡5例（4.4%）,其中2例死于多器官功能衰竭，1例死于低心排血量综合征，1例死于左心衰竭，1例死于恶性心律失常。其余患者均顺利脱离呼吸机，痊愈出院。108例患者获得随访,随访时间2～110个月,心功能Ⅰ级63例,Ⅱ级31例,Ⅲ级12例;复发3例,2例再次手术后痊愈出院；远期死亡2例，均为恶性粘液瘤。 结论 心脏粘液瘤患者被确诊后应尽快手术治疗,其效果满意,彩色超声心动图对诊断及随访均具有重要作用。

以眼部症状为首发表现的心脏粘液瘤二例

Pathological types and age distribution of primary left ventricular tumors

ObjectiveTo summarize the age distribution of different pathological types of primary left ventricular tumor and its influence on preoperative diagnosis, surgical methods and therapeutic effect.Methods The clinical data of 35 patients with primary left ventricular tumor admitted to Fuwai Hospital of Chinese Academy of Medical Sciences from January 2008 to March 2019 were retrospectively analyzed. There were 19 males and 16 females with an average age of 33.81±17.56 years. According to the age, the patients were divided into an infant group (less than 7 years), an adolescent group (7-17 years), a young group (18-44 years), a middle-aged group (45-59 years) and an elderly group (over 60 years). The age distribution characteristics of different pathological types of tumor patients were analyzed, and the influence on surgical methods, short-term and long-term curative effect of surgery in different age groups was analyzed. Within 6 months after the operation, the patients returned to the hospital to review the echocardiography, and then were followed up by telephone.Results Of the 35 patients with primary left ventricular tumor, only 1 patient in the middle-aged group had low malignancy carcinoid tumor, and the others were benign tumors. Fibroma and rhabdomyoma accounted for the majority of the infant group and adolescent group. Myxoma was the common tumor in the young group, middle-aged group and elderly group, followed by lipoma. Thirty-three patients were operated under general anesthesia, hypothermia and cardiopulmonary bypass (CPB). Two patients with epicardial lipoma underwent normothermic surgery without CPB. Nine patients underwent partial resection of left ventricular tumors, and 26 patients received complete resection of left ventricular tumor. There was no hospital death, opening stanching, secondary thoracotomy, low cardiac output, embolism or other complications. The postoperative hospital stay was 7.97±2.56 days, and the postoperative reexamination was normal. Subsequently, 35 patients were followed up by telephone or outpatient service. The average follow-up time was 59.87±37.62 months. In the young group, 2 patients with partial resection recurred.Conclusion Surgical resection is the first choice for the treatment of left ventricular benign tumor, and it is safe. The principle of left ventricular tumor surgery is to protect the function of ventricle and valve, prevent damage to the conduction system, and remove the tumor as completely as possible.

The clinical application of minimally invasive technique in surgical treatment of cardiac tumors

Objective To share clinical experience of minimally invasive technique in surgical treatment of cardiac tumors. Methods Clinical data of 50 patients with cardiac tumors who underwent surgical teatment in Zhongshan Hospital of Fudan University from January 2011 to September 2014 were analyzed retrospectively. There were 18 males and 32 females aged from 32 to 65 years (mean age 47 years). Cardiac tumors were located in the left atrium in 44 (88%) patients and right atrium in 6 (12%) patients. Results There was no in-hospital death. All patients recovered well without any complications. Mean total operating, cardiopulmonary bypass and aortic cross-clamp time was 148±45 min, 56±23 min, 26±16 min, respectively. The average time to extubation was 5±3 hours and the median length of stay in the intensive care unit (ICU) and in the hospital was 9±6 hours and 5±3 days, respectively. All patients were followed up for 1 to 44 months without tumor recurrence except one. Conclusion Minimally invasive technique in surgical treatment of cardiac tumors via right anterolateral thoracotomy is a safe and feasible method with good cosmetic results and rapid postoperative recovery, and is worthy of clinical selective application for treatment of benign cardiac tumor.

Research advances in genetics and molecular biology of primary cardiac tumors

Primary cardiac tumors, which originate from the heart, are uncommon and can be classified as benign or malignant, with the majority being benign. Malignant primary cardiac tumors have a poor prognosis. Benign ones may also cause severe hemodynamic and electrophysiological consequences, but the prognosis is generally good if they are detected early and treated properly. In recent years, researches on the genetic and molecular causes of primary cardiac tumors have yielded some promising breakthroughs, with some of them already being translated into clinical practice. This article reviews research progress and its use in precise diagnosis and targeted therapy from the perspective of DNA, RNA, and protein changes, as well as prospects the promising research directions in the future.

Short-term effect of minimally invasive thoracoscopic cardiac surgery in 453 patients: A retrospective study in a single center

ObjectiveTo analyze the short-term outcomes of cardiac surgery via minimally invasive approach under thoracoscope in a single-center. Methods The clinical data of patients who underwent cardiac surgery via minimally invasive approach under thoracoscope between July 2017 and February 2022 were retrospectively analyzed. Results A total of 453 patients were enrolled, including 150 males and 303 females at an average age of 42.2±14.6 years. The main disease types included atrial septal defect in 314 patients, partial atrioventricular septal defect in 26 patients, and cardiac tumor in 105 patients. There was no death during the perioperative period. The mean operative time was 3.9±0.8 h, cardiopulmonary bypass time was 101.2±34.0 min, aortic occlusion time was 42.1±25.1 min, ventilator assistance time was 11.6±9.4 h, ICU stay time was 22.6±13.9 h and postoperative hospital stay was 6.0±1.7 d. Intraoperative and postoperative complications occurred in 18 (4.0%) patients, including 2 patients with conversion to sternotomy, 3 with incision expand, 3 with reoperation for bleeding, 1 with of redo operation, 4 with incision infection, 2 with respiratory insufficiency, 2 with cerebrovascular accident, and 1 with ventricular fibrillation. The follow-up time was 22.6±15.4 months, during which 1 patient died, 4 patients had moderate mitral regurgitation, 1 patient had mild-moderate mitral regurgitation, and 1 patient had mild-moderate tricuspid regurgitation. Conclusion Minimally invasive cardiac surgery under thoracoscope is safe with small invasions and few complications, and has satisfactory short-term outcomes.