心脏瓣膜肿瘤的超声特征

Ultrasonographic Features of Cardiac Valve Tumors

目的分析心脏瓣膜肿瘤的超声特征和病理结果,为提高其诊断水平提供参考。资料与方法回顾性收集2002年1月—2020年12月空军军医大学西京医院连续确诊的28例心脏瓣膜肿瘤患者的超声心动图及病理资料,分析其常见病理类型、好发部位、临床及超声特征。结果28例心脏瓣膜肿瘤中,21例(75.0%)为良性,最常见的类型为黏液瘤(12/28,42.9%),其次为乳头状弹力纤维瘤(3/28,10.7%);恶性发生率最高者为肉瘤(3/28,10.7%)。18例患者有症状,对瓣膜功能有一定影响:梗阻、关闭不全发生率分别为39.3%(11/28)、21.4%(6/28)。肿瘤发生于右心者症状更明显(P=0.023)、右心室面积变化率更低(t=2.819,P=0.009)。恶性心脏瓣膜肿瘤的瘤体最大径、最大径/基底比值、瘤体纵横比及右心室面积变化率与良性比较,差异有统计学意义(Z=-3.585、-3.581、-3.901,t=2.570;P<0.05)。随访结果显示,良性心脏瓣膜肿瘤患者死亡率低于恶性者(4.8%比85.7%,P=0.02)。恶性心脏瓣膜肿瘤患者总体中位生存期12(19)个月。结论心脏瓣膜肿瘤以良性居多,但对瓣膜功能有一定影响,常引起梗阻,右心系统瓣膜肿瘤患者症状更显著;瘤体最大径、最大径/基底比值、瘤体纵横比及右心室面积变化率等超声参数在提示心脏瓣膜肿瘤良恶性方面有一定参考价值。

Purpose To provide a basis for improving the diagnostic level of cardiac valve tumors by analyzing the echocardiography and pathological results.Materials and Methods The echocardiographic and pathological data of 28 patients diagnosed continuously as heart valve tumors in Xijing Hospital of Air Force Military Medical University from January 2002 to December 2020 were collected retrospectively.The common pathological types,predilection sites,clinical and ultrasonic imaging features of heart valve tumors were analyzed.Results Among these 28 patients with valvular tumors,21(75.0%)were benign,myxoma(12/28,42.9%)was the most common type,and followed by papillary fibroelastoma(3/28,10.7%).The most common malignant tumor was sarcoma(3/28,10.7%).A total of 18 patients had symptoms,but valvular tumors showed limited impact on valve function:the incidence of obstruction and insufficiency were 39.3%(11/28)and 21.4%(6/28),respectively.The symptoms of right ventricle(RV FAC)was more obvious than that of left ventricle(P=0.023).The fractional area change of RV FAC was significantly lower than that of left ventricle(t=2.819,P=0.009).There were significant differences in the mass maximum diameter,the ratio of the maximum diameter to base,the ratio of longitudinal to transverse diameter and RV FAC between the malignant group and benign group(Z=-3.585,-3.581,-3.901,t=2.570;P<0.05).The mortality of the benign group was much lower than that of the malignant group(4.8%vs.85.7%,P=0.02).The average survival time of the malignant group was 12(19)months.Conclusion Cardiac valve tumors are mostly benign,but they often cause valve dysfunction,commonly with obstruction.Patients with valve tumors in the right heart system have more significant symptoms.Ultrasound parameters including maximum diameter of the tumor,maximum diameter/base diameter ratio,aspect ratio of the tumor,and fractional area change of the right ventricle have certain reference value in indicating benign and malignant valve tumors.