Hepatocellular carcinoma with tumor thrombus extends to the right atrium and portal vein:A case report

BACKGROUND Hepatocellular carcinoma(HCC)is the most important primary malignant liver disease.A large proportion of patients with advanced HCC have macrovascular invasion.HCC tends to infiltrate vascular structures,particularly the portal vein and its branches,and more rarely,the hepatic veins.The intravascular tumor thrombus can affect the inferior vena cava(IVC)or even the right atrium(RA),the latter having a poor prognosis.CASE SUMMARY HCC is one of the most aggressive malignant tumors.Tumor thrombus(TT)formation in advanced HCC stages is common and usually involves the hepatic or portal veins.Herein,we report a 69-year-old woman who presented with dyspnea to the emergency department.A ventilation/perfusion lung scan was performed,ruling out pulmonary embolism.Hepatopulmonary syndrome and portopulmonary hypertension were discarded with contrasted echocardiography,but a mass in the RA was detected and confirmed by cardiac magnetic resonance imaging.Abdominal computed tomography showed a liver mass with a dynamic enhancement pattern compatible with HCC and an intraluminal IVC mass extending from the hepatic vein into the RA.HCC with TT expansion to IVC and RA is rare and indicates poor prognosis.CONCLUSION HCC with TT expansion to IVC and RA is rare and indicates poor prognosis.There is no consensus about anticoagulation or other interventions in these patients.

Right Atrium Myxoma in an 11-Year-Old Girl in Guinea

The objective of this study was to describe the myxoma of the right atrium occurring in an 11-year-old girl. It was an 11-year-old girl weighing 22 kg, admitted for exertional dyspnea, dry cough, palpitations, hepatitis, abdominal bloating, fever evolving for more than 9 months without a history of known cardiovascular disease;referral from a pulmonology department for cardiomegaly and right pleurisy. At cardiac auscultation, the rhythm was irregularly fast at 130 beats without added noise with a blood pressure of 110/65 mmhg. In the lungs, there was silence and a decrease in vocal vibrations at the right base, SaO2 at 70%. Elsewhere a thoracic collateral venous circulation was visible. Electrocardiogram recorded rapid atrial fibrillation at 134 cycles. The cardiac ultrasound concluded that there was a mobile mass in the right atrium prolapsing in the right ventricle measuring 25 mm × 18.9 mm suggesting a myxoma. The myxoma of the right atrium is of a rare localization with a polymorphic clinical manifestation. It should be diagnosed as early as possible to avoid the occurrence of dreaded complications. Its management is surgical.

Clinical value of ^(18)F-FDG PET/CT in evaluation of hepatic vein,inferior vena cava and right atrium tumor thrombi in hepatocellular carcinoma:Initial results

In this paper,eleven consecutive hepatocellular carcinoma(HCC) patients with an embolus in the hepatic vein(HV),inferior vena cava(IVC)and right atrium(RA) were studied with 18F-FDG PET/CT and contrast enhanced CT.When correlated with final diagnosis,18F-FDG PET/CT and contrast enhanced CT was positive in 11 patients(100%),7 patients(63.6%),respectively.The accuracy of PET/CT and contrast-enhanced CT were 100%,63.6%.Three cases with secondary blood thrombi in the distant IVC,which were confirmed by PET/CT,cannot be identified by contrast enhanced CT.The average survival was 3 months(range,1-12mo).The 12 months survival rate was 9.1%.Our results suggest that highly metabolic tumor thrombus in the HV,IVC and RA may be depicted on 18F-FDG PET/CT in HCC patients.It may discriminate between malignant and secondary benign blood thrombi.

A Primary Epithelioid Hemangioendothelioma of the Right Atrium: Report of a Case and Literature Review

Primary cardiac epithelioid hemangioendothelioma (EHE) is extremely uncommon. To our knowledge, only fourteen cases have been reported. We report a case of a primary EHE of the right atrium which incidentally detected in 77-year-old woman. Echocardiograhpy revealed a 26 × 16 mm right atrial mass attached to the base of the interatrial septum and moderate regurgitation of the tricuspid valve. The tumor and stalk were completely resected from the interatrial septum with a partial resection of the septal leaflet of the tricuspid valve. The patient had an uneventful postoperative course and no signs of recurrence nor metastasis of EHE 4 years after operation. Because of malignant potential of EHE, a longer period of close follow up is necessary.

Insights into treatment for hepatocellular carcinoma with tumor thrombus in the inferior vena cava or right atrium

Hepatocellular carcinoma(HCC),one of the most common liver cancers,often has a poor prognosis when it involves macrovascular invasion.Oncological emergencies including pulmonary embolism,heart failure,and even sudden death could happen when it develops a tumor thrombus(TT)in the inferior vena cava(IVC)or right atrium(RA),indicating an exceptionally grim prognosis(1).Although systemic therapy is the only standard treatment recommended by guidelines(2),other treatment modalities are explored including surgery,radiotherapy,etc.in some centers.Surgery,as the only potential curative treatment,has been explored in several selected cases.A case of long-term survival of 15 years and cancer-free survival of 9 years was reported by surgical resection with a heart-first approach under cardiopulmonary bypass(CPB)(3),suggesting that aggressive surgery together with multidisciplinary treatments might achieve long survival.However,due to the aggressiveness and challenge of surgical resection-massive resection area,potential significant blood loss,and bypass needed,surgical resection is applied in very limited centers.Nevertheless,safety,efficacy,and long-term survival benefits for these patients are poorly investigated.

Expression of ion-channel subunit mRNA in different regions of canine right atrium

A trial electrophysiological heterogeneity, which plays an important role in the genesis and maintenance of atrial arrhythmia, is a major determinant of atrial reentrant arrhythmias. Recently, many studies on atrial flutter have demonstrated the anatomic architecture in the right atrium plays an important role in the genesis of atrial reentry. The crista terminalis （CT） in the right atrium, which is a unique anatomic structure of the right atrium, provides an area for conduction block and delay, leading to initiation, maintenance, and termination of atrial arrhythmias. Catheter ablation of CT can successfully eliminate these atrial arrhythmias. These literatures contrast with limited knowledge of the basic electrophysiological properties of CT and how these promote arrhythmia generation. Compared to pectinate muscles （PM） and right atrial appendage （RAA）, CT have distinct electrophysiological properties related to different densities of several ionic currents, the transient outward current （Ito） and L-type Ca^2＋ current （Ica-L） underlie the bulk of the different densities of several ionic currents. Cardiac Ito and Ica-L play a major role in action potential repolarization. Ito is particularly important in early （phase 1） repolarization and influences the participation of other currents. It is generally believed that Ica-L plays an important role in the plateau phase of repolarization. However, the mechanisms for these ionic current differences are unknown. One possible is a difference in ion channel subunit expression, but virtually no data are available regarding ion-channel subunit expression in CT, PM, and RAA. The Kv4.3 channel underlies the bulk of the α-subunit of Ito in canine and human heart.

Electro-anatomic mapping of the right atrium:anatomic abnormality is an important substrate

Objective To map and compare the right atrium in patients with AF to those with atrioventricular nodal reentrant tachycardias (AVNRT, as control group) and to investigate the anatomical and electrophysiological abnormality of the right atrium in AF.Methods The anatomy and electrophysiology of right atrium and cavotricuspid isthmus were evaluated in 20 patients with AF (16 M/4 F, mean age 55.9±10.68 years) and 26 patients with AVNRT (9 M/17 F, mean age 47.50±19.56 years) during coronary sinus pacing at 600 ms prior to ablation with electro-anatomical mapping system. Right atrial volume (RAV), the length and width of cavotricuspid isthmus (IsL, IsW), unipolar and bipolar voltage in the right atrium (UniV-RA, BiV-RA) were measured and compared between patients with AF and those with AVNRT. Results RAV, IsL, IsW, UniV-RA, and BiV-RA were 143.22±40.72 vs 104.35±21.06 ml, 39.31±8.10 vs 32.42±9.77 mm, 30.54±7.48 vs 23.15±6.61 mm, 1.96±1.24 vs 1.53±0.91 mv and 1.47±1.47 vs 1.29±1.12 mv in AF and AVNRT respectively.Conclusion The right atrial volume is larger; both the length and width of cavotricuspid isthmus are greater. Unipolar and bipolar voltages in the right atrium are higher in AF than in AVNRT, suggesting that the enlarged right atrium, increased length and width of cavotricuspid isthmus, and concomitant atrial hypertrophy are important substrates for initiation and perpetuation of typical AF.

静脉-静脉ECMO上腔灌注管与下腔引流管间距对右心房内血流动力学影响的数值研究

目的阐明静脉-静脉ECMO(veno-venous extracorporeal membrane oxygenation,VV-ECMO)上腔灌注管与下腔引流管间距对右心房内血流动力学环境的影响规律。方法基于一名呼吸衰竭患者的心脏MRI影像数据建立右心房三维模型,以Medtronic 23Fr型插管为基础建立上腔灌注管模型和下腔引流管模型;分别建立上腔灌注管与下腔引流管间距与上下腔静脉距离之比为38%、88%、126%三种情况的流固耦合模型。采用瞬态计算流体力学方法研究右心房内血流动力学状态。采用血流速度云图、再循环率(recirculation fraction,RF)、右心房内低流速区域体积和相对停滞时间(relative residence time,RRT)等参数来评价不同上腔灌注管与下腔引流管间距下右心房内的血流动力学变化。结果随着上下腔静脉插管距离的增加,右心房内低流速区域总体积先降低后增加(468 mm 3 vs.327.47 mm 3 vs.357.7 mm 3);相对停滞时间最大值先降低后增加(103.54 Pa-1 vs.70.60 Pa-1 vs.95.15 Pa-1);再循环率不断降低(23.295%vs.20.918%vs.10.88%)。结论低流速区域体积和RRT的改善与插管间距的增大并不是线性的,当插管间距增加到一定距离时,继续增加插管间距,低流速区域体积和相对停滞时间指标反而会变差。再循环率则随着插管间距的增大而不断改善。

Imaging findings and transcatheter arterial chemoembolization of hepatic malignancy with right atrial embolus in 46 patients

AIM: To analyze the imaging findings of hepatic malignancy with right atrial (RA) embolus. METHODS: Forty-six patients with an embolus in the RA were diagnosed, including 44 patients with hepatocellular carcinoma (HCC), 1 patient with cholangiocellular carcinoma and 1 patient with hepatic carcinoma metastasis. The diagnosis was confirmed by clinical examination, serum α-fetoprotein and imaging. Seventeen patients underwent transcatheter arterial chemoembolization (TACE). RESULTS: On enhancement computer tomography (CT) or magnetic resonance (MR) imaging, a nodular filling defect in the RA could be easily found, with a slight enhancement in the arterial phase. The coronal images of CT or MR showed the extent of lesion. Lipiodol entered the embolus after TACE, hence reducing the speed of embolus growth. There was a survival benefit for patients receiving anticancer treatment. CONCLUSION: Patients with HCC, showing a filling defect of the inferior vena cava (IVC), hepatic vein (HV) and RA on images, can be diagnosed with RA embolus. Encroachment of the RA is very rare in patients with hepatic malignancies. Furthermore, a prolongation of survival time is found in those patients who underwent TACE.

Dynamic Characteristic Mechanism of Atrial Septal Defect Using Real-Time Three-Dimensional Echocardiography and Evaluation of Right Ventricular Functions

The dynamic characteristics of the area of the atrial septal defect（ASD） were evaluated using the technique of real-time three-dimensional echocardiography（RT 3DE）, the potential factors responsible for the dynamic characteristics of the area of ASD were observed, and the overall and local volume and functions of the patients with ASD were measured. RT 3DE was performed on the 27 normal controls and 28 patients with ASD. Based on the three-dimensional data workstations, the area of ASD was measured at P wave vertex, R wave vertex, T wave starting point, and T wave terminal point and in the T-P section. The right atrial volume in the same time phase of the cardiac cycle and the motion displacement distance of the tricuspid annulus in the corresponding period were measured. The measured value of the area of ASD was analyzed. The changes in the right atrial volume and the motion displacement distance of the tricuspid annulus in the normal control group and the ASD group were compared. The right ventricular ejection fractions in the normal control group and the ASD group were compared using the RT 3DE long-axis eight-plane（LA 8-plane） method. Real-time three-dimensional volume imaging was performed in the normal control group and ASD group（n=30）. The right ventricular inflow tract, outflow tract, cardiac apex muscular trabecula dilatation, end-systolic volume, overall dilatation, end-systolic volume, and appropriate local and overall ejection fractions in both two groups were measured with the four-dimensional right ventricular quantitative analysis method（4D RVQ） and compared. The overall right ventricular volume and the ejection fraction measured by the LA 8-plane method and 4D RVQ were subjected to a related analysis. Dynamic changes occurred to the area of ASD in the cardiac cycle. The rules for dynamic changes in the area of ASD and the rules for changes in the right atrial volume in the cardiac cycle were consistent. The maximum value of the changes in the right atrial volume occurred in the end-systolic period when the peak of the curve appeared. The minimum value of the changes occurred in the end-systolic period and was located at the lowest point of the volume variation curve. The area variation curve for ASD and the motion variation curve for the tricuspid annulus in the cardiac cycle were the same. The displacement of the tricuspid annulus exhibited directionality. The measured values of the area of ASD at P wave vertex, R wave vertex, T wave starting point, T wave terminal point and in the T-P section were properly correlated with the right atrial volume（P〈0.001）. The area of ASD and the motion displacement distance of the tricuspid annulus were negatively correlated（P〈0.05）. The right atrial volumes in the ASD group in the cardiac cycle in various time phases increased significantly as compared with those in the normal control group（P=0.0001）. The motion displacement distance of the tricuspid annulus decreased significantly in the ASD group as compared with that in the normal control group（P=0.043）. The right ventricular ejection fraction in the ASD group was lower than that in the normal control group（P=0.032）. The ejection fraction of the cardiac apex trabecula of the ASD patients was significantly lower than the ejection fractions of the right ventricular outflow tract and inflow tract and overall ejection fraction. The difference was statistically significant（P=0.005）. The right ventricular local and overall dilatation and end-systolic volumes in the ASD group increased significantly as compared with those in the normal control group（P=0.031）. The a RVEF and the overall ejection fraction decreased in the ASD group as compared with those in the normal control group（P=0.0005）. The dynamic changes in the area of ASD and the motion curves for the right atrial volume and tricuspid annulus have the same dynamic characteristics. RT 3DE can be used to accurately evaluate the local and overall volume and functions of the right ventricle. The local and overall volume loads of the right ventricle in the ASD patients increase significantly as compared with those of the normal people. The right ventricular cardiac apex and the overall systolic function decrease.

静脉输液港导管脱落至右心房1例报道

对于肿瘤患者及需要长期进行各种静脉输液治疗的患者而言,反复的静脉穿刺和药物刺激,不仅给患者带来痛苦,而且增加护士的操作难度及工作负担,管路维护也极不方便。随着医疗技术的不断发展和输液港在临床上的普及,以及其使用周期长、操作简便、维护少等优势,输液港被越来越多的患者所接受,但输液港在放置及使用过程中也发生了一些相关的并发症,其中导管脱落(断裂)是最严重的并发症。本文通过报道核工业四一七医院1例静脉输液港导管脱落至右心房的病例,结合输液港植入时穿刺路径的选取、静脉输液港的连接方式与技巧,从医生操作、护理人员维护及患者自身管理等方面对导管脱落的相关因素进行全面分析,从而制订应对措施,预防及减少导管脱落风险。

右心房在术后心房颤动复发中的研究进展

心房颤动(房颤)已经日益引起全球的关注,随着年龄的增长,房颤的发病率逐年增加。由于房颤临床治疗策略的不断发展,射频消融术逐渐取代常规药物治疗,已成为房颤的临床一线治疗手段,能大幅度地减少房颤负荷、控制房颤节律及改善心脏功能。然而术后心房颤动复发率仍然是一个重要的临床问题。大量研究证明,房颤持续存在,左心房会发生电生理及解剖结构的重构,这是房颤发生发展和维持以及术后复发的重要病理因素。但近期的研究发现,右心房参与维持心房颤动,并且随着房颤持续时间的增加,右心房与房颤患者的临床结果较差独立相关,对于房颤术后复发的预测作用也存在一定的相关性。本文旨在对右心房与消融术后房颤复发相关性进行综述。

多种影像学检查评估肺动脉高压患者右心房结构及功能的应用进展

肺动脉高压是一种高发生率、高死亡率性疾病。右心房增大及功能障碍与肺动脉高压患者临床恶化进展息息相关。积极评估右心房结构和功能对肺动脉高压患者至关重要。超声心动图检查、CT检查、心脏磁共振成像都能够评价右心房结构和功能,且每种影像学都有其独特的优势和相应的不足,不可相互替代。本文就多种影像学对肺动脉高压患者右心房结构和功能评估中的应用进展做一综述。

Right atrial angiosarcoma and electrocardiogram-gated cardiac computed tomography:a case report

Primary cardiac tumors are quite rare and most of these tumors are benign.In this report,a patient presented with chest distress and shortness of breath after activity.Echocardiography of other hospital showed a hyperechoic right atrial mass.Electrocardiogram-gated cardiac computed tomography(ECG-Gated CT) of our hospital provided accurate information about the site and extent of the tumor,and the involvement of neighboring structures,even about the malignant nature of the lesion.The pathological study indicated angiosarcoma.The role of ECG-Gated CT in the assessment of cardiac masses and tumors was discussed.Cardiac tumors are extremely rare and can be divided into benign and malignant lesions.Myxomas are the most common type of cardiac benign tumor,while angiosarcomas are the most common type of cardiac malignant tumor.Imaging studies play an important role in the diagnosis of cardiac angiosarcomas.Echocardiogram,computed tomography(CT) and magnetic resonance imaging(MRI) are the most common imaging studies for tumors evaluation.However,the precise tumor location is often difficult to evaluate precisely on the basis of two-dimensional source images.We conducted ECG-gated cardiac CT examination with 3D reconstruction for preoperative assessment in a patient with a angiosarcoma arising in the right atrium.

Ball-shaped right atrial mass in renal cell carcinoma: A case report

BACKGROUND Renal cell carcinoma(RCC)is an aggressive tumor,with an incidental discovery in most patients.Classic presentation is rare,and it has a high frequency of local and distant metastasis at the time of detection.CASE SUMMARY We present a rare case of a 58-year-old man with a ball-shaped thrombus in the right atrium at the time of first incidental identification of RCC in the emergency department.Cardiac metastasis,especially thrombus in the right atrium,is rare.It could either be a bland thrombus or a tumor thrombus,and physicians should consider this potentially fatal complication of RCC early at the time of initial presentation.CONCLUSION Ball-shaped lesions in the right atrium are rare,and bland thrombus should be differentiated from tumor thrombus secondary to intracardiac metastasis.

Right Atrial Myxoma—A Case Report

Myxomas comprise 6% to 10% of primary cardiac tumors in childhood. Less than 10% of patients with cardiac myxomas are under 15 years of age. A large myxoma occupying in the right atrium and prolapsing into the right ventricle, pulmonary artery and producing tricuspid and pulmonary valve obstructions was diagnosed by Transthoracic 2D echocardiographic imaging in a 12-year-old male child.

儿童先天性右心房畸形的超声心动图诊断价值及漏误诊分析

目的 探讨彩色多普勒超声心动图对儿童先天性右心房畸形(congenital malformations of the right atrium, CMRA)的诊断价值,分析漏诊与误诊原因,提高超声心动图对儿童CMRA的首次检出率。方法 选取并分析22例经手术与MRI及CT诊断为CMRA的患儿资料,其中11例行胸外科手术治疗。结果 本组原发性右心房扩张15例、右心房憩室3例、原发性右心耳扩张3例、冠状静脉窦憩室1例。单纯性CMRA患儿10例,合并畸形12例,包括卵圆孔未闭5例、房间隔缺损4例、三尖瓣轻-中度反流3例、三尖瓣发育不良1例、三尖瓣重度反流1例;7例合并阵发性室上性心动过速等严重的心律失常。22例超声诊断正确18例(81.8%);漏诊与误诊4例(18.2%),其中误诊3例,漏诊1例;1例右心房憩室误诊为原发性右心房扩张,1例原发性右心房扩张误诊为原发性右心耳扩张,1例冠状静脉窦憩室误诊为冠状静脉窦狭窄,1例原发性右心房扩张漏诊。结论 彩色多普勒超声心动图可以比较准确地诊断儿童CMRA,但容易漏、误诊。

经腹腔心包路径肝上下腔静脉与右心房吻合肝移植治疗布-加综合征合并肝癌1例附手术视频

目的总结经腹腔心包路径供肝肝上下腔静脉与受者右心房吻合肝移植治疗布-加综合征(BCS)合并肝癌的相关经验。方法回顾性分析1例经腹腔心包路径肝上下腔静脉与右心房吻合肝移植治疗BCS合并肝癌病例的临床资料。结果患者的肝静脉和肝上下腔静脉局部闭塞,在心脏不停跳情况下,采用经腹腔心包路径完成肝上下腔静脉与右心房吻合肝移植,此外,由于受者肝动脉病变,采用受者脾动脉切断,远端结扎,近端反转与供肝肝总动脉吻合,完成肝动脉重建,手术过程顺利。术后1周左右移植肝肝功能逐步恢复正常,无重大并发症发生。患者术后25 d出院,随访8个月余无BCS复发征象。结论经腹腔心包路径肝上下腔静脉与右心房吻合肝移植治疗BCS是安全可行的,对于合并肝癌的患者预后较好。

超声心动图评估房间隔缺损右心功能的临床应用进展

房间隔缺损(ASD)是常见的左向右分流型先天性心脏病(CHD),血流动力学变化主要为右心容量负荷增加。目前对于心脏功能的评价主要集中于左心室,随着超声心动图新技术的发展,筛选出新的右心功能评估指标和方法辅助临床更好地制定诊疗策略、判断预后逐渐成为了研究热点。

3'-大豆苷元磺酸钠对豚鼠离体右心房自律性及收缩特性的影响

目的研究3'-大豆苷元磺酸钠对豚鼠离体右心房自律性及收缩特性的影响,并探讨其作用机制。方法采用豚鼠离体右心房测定3'-大豆苷元磺酸钠对其自律性、收缩幅度、收缩速度、舒张速度的影响。结果3'-大豆苷元磺酸钠可降低豚鼠离体右心房的自律性,明显降低豚鼠离体右心房的收缩幅度、收缩速度、舒张速度,且具有明显的剂量依赖性。结论3'-大豆苷元磺酸钠可抑制豚鼠离体右心房的自律性,明显降低豚鼠离体右心房的收缩幅度、收缩速度、舒张速度,且具有明显的剂量依赖性。其作用机制可能与阻断电压依赖性Ca2+通道及抑制肌浆网对Ca2+的释放有关。