心脏血管瘤的超声心动图表现及临床分析

Clinical analysis and echocardiographic manifestations of cardiac hemangioma

目的探讨心脏血管瘤的临床表现、病理学类型以及超声心动图表现。方法回顾性分析2010年1月至2020年3月在浙江大学医学院附属第一医院行外科手术并经病理确诊的7例心脏血管瘤患者的临床资料及术前超声心动图检查资料。结果7例患者中,其中2例出现心悸、胸闷和气短,1例出现上腹部不适,余4例无明显症状。术后病理结果提示:海绵状血管瘤4例,毛细血管瘤1例,2例未明确诊断血管瘤类型。术前超声心动图诊断心脏及心包占位性质待定4例,诊断黏液瘤可能性大2例,诊断乳头状弹力纤维瘤1例。1例右房室交界处肿瘤误诊为心包肿瘤。术后随访3个月至6年,其中3例患者均恢复情况良好,1例患者术后出现右冠状动脉右心室瘘,3例失访。结论心脏血管瘤患者无特异性临床表现,超声心动图显示血管瘤的形态表现多样,于血管瘤的定性诊断有一定难度,尚有待相关病历资料和临床经验的不断积累和总结。

Objective To investigate the clinical manifestations,pathological types,and echocardiographic manifestations of cardiac hemangioma.Methods The clinical data and preoperative echocardiographic data of seven patients with cardiac hemangioma who had undergone surgery and were diagnosed by pathology at The First Affiliated Hospital,College of Medicine,Zhejiang University from January 2010 to March 2020 were analyzed retrospectively.Results Among the seven patients,two had palpitations,chest tightness,and shortness of breath,one had upper abdominal discomfort,and the remaining four had no obvious symptoms.The postoperative pathological results showed that there were four cases of cavernous hemangioma,one case of capillary hemangioma,and two cases of undiagnosed hemangioma type.Preoperative echocardiographic findings suggested heart and pericardial space-occupying nature to be determined in four cases,the possibility of myxoma in two,and the diagnosis of papillary elastofibroma in one.One case of tumor at the right atrioventricular junction was misdiagnosed as a pericardial tumor.The postoperative follow-up was 3 months to 6 years.Three patients recovered well,one developed right coronary artery and right ventricular fistula after surgery,and the other three were lost to follow-up.Conclusion Patients with cardiac hemangioma have no specific clinical manifestations.Echocardiograms show that the morphological manifestations of hemangioma are diverse.It is difficult to qualitatively diagnose hemangioma.The relevant medical records and clinical experience remain to be accumulated and summarized.