心房黏液瘤合并动脉栓塞的CT表现与临床治疗

CT findings and clinical treatment of atrial myxoma and sequent arterial embolism

目的探讨心房黏液瘤合并动脉栓塞的CT表现、临床治疗及疗效。方法收集6例左心房黏液瘤合并动脉栓塞患者,均于完善包括冠状动脉及外周动脉CTA检查在内的相关检查后行手术治疗;对其CTA表现及临床资料进行回顾性分析。结果 6例心房黏液瘤均发生于左心房,CT平扫呈低密度,3例动脉期强化,蒂宽窄不等,1例伴有钙化;6例均伴有动脉栓塞,栓塞部位为髂动脉2例、肱动脉1例、股动脉2例和腹主动脉伴两侧髂动脉多发栓塞1例。采用同期或分次心房黏液瘤切除联合外周动脉Fogarty导管取栓术进行治疗,无死亡病例,术后患者肢体疼痛消失。随访6个月～2年,均无心房黏液瘤复发或取栓部位黏液瘤再发种植转移,受累肢体血运良好。结论 CTA可对心房黏液瘤合并动脉栓塞作出较全面的诊断;采用心房黏液瘤切除辅以栓塞动脉Fogarty导管取栓术进行联合治疗可获得满意疗效。

Objective To explore the CT findings, clinical therapies and effects of atrial myxoma and sequent arterial em- bolism. Methods Totally 6 patients with left atrial myxoma and sequent arterial embolism were collected. After biochemical tests and relative necessary examinations including large artery and coronary artery CTA, surgical treatment was performed for all 6 patients. CTA findings and clinical data were retrospectively analyzed. Results All the tumors located in left atrium, attaching to the fossa ovalis or its surroundings, present low density on plain, while enhancement was noticed in 3 cases after injection of contrast media. The bases of myxoma were in different widths, and calcification could be seen in 1 case. The emboli secondary to atrial myxomas located in iliac artery in 2 cases, brachial artery in 1 case, femoral artery in 2 cases and simultaneously abdominal aorta and bilateral iliac artery in 1 case. Surgical excision of atrial tumor and Fogarty balloon catheter thromboembolectomy were performed at the same time or separately. The clinical symptoms disappeared after treatment, and no death occurred after surgery. No atrial myxoma nor planted artery embolism reoccurred during following up period for 6 months to 2 years after operation. Conclusion CTA can comprehensively evaluate the atrial myxoma and sequent arterial embolism. Combined treatment of surgical excision of atrial myxoma and Fogarty balloon catheter thromboembolectomy can achieve satisfactory curative effect for atrial myxoma and sequent arterial embolism.