myxoma - it intracavitary primary tumor of the heart, characterized benign course and endocardial origin.Due to the fact that myxoma has a characteristic rounded shape and is attached to the inner wall by means of a long "legs" when it has the form echocardioscopy movable neoplasms with clear smooth contours.
of the total number of cancer patients with cardiac disease profile is dominated by patients who have been left atrial myxoma, that is not less than 75%.The defeat of the right atrium and atrial septal observed much less frequently, and often presents multiple tumors in all the cavities of the heart.
major category of risk for this cancer pathology make the elderly, but a small percentage of the cases submitted to the hereditary form of the myxoma, which can manifest itself at any age period, and is not depending on gender.
inherited form myxoma different polymorphic clinical and pathological manifestations, and therefore, the patient may experience common
Because this tumor is found in the structure of cancer pathology is extremely rare, etiopathogenesis of this disease is poorly understood, but it is known that proliferation and myxomatous degeneration develops from the endothelium.In recent years, the scientific study of the effects of cardiac surgery leads to the conclusion that the development of the myxoma to some extent contributes to the intra-cardiac surgery history (percutaneous balloon dilatation of the mitral valve, plastic septal defects).
Symptoms and signs of myxoma
myxoma is characterized by polymorphism of clinical manifestations, but each of the individual symptoms experienced by a patient can be attributed to one of three pathognomonic syndromes: general clinical syndrome, syndrome disorders intracavitary blood flow and embolic syndrome.Note that myxoma is classified as rapidly progressing cancer pathology, characterized by rapid growth and a significant increase in tumor substrate.
most common and at the same time non-specific syndrome is clinical, the symptoms of which are observed in 90% of patients with myxoma.The patient complained of progressive weakness, inability to perform usual physical activity, decreased appetite, fever sluggish and aching joints in different groups.A more detailed examination of the patient with the above symptoms are detected following clinical and laboratory signs of the disease: type of hemolytic anemia, inflammatory changes in the blood, Dysproteinemia with elevated levels of immunoglobulins.
embolic syndrome develops in the separation of the substrate or the formation of tumor thrombotic layers in the cavity of the atria and their subsequent spread to the current circulating in the blood of one or another section of the circulatory system.In a situation where an embolus overlaps cerebral blood flow, the patient has acute transient ischemic attack, consisting of the short-term loss of consciousness, and the appearance of brain focal neurological symptoms.Tumor embolus may impede any blood flow in a blood vessel, even the smallest caliber, for example, retinal artery that leads to irreversible consequences in the form of loss of visual function.For the development of embolic events in the pool of the pulmonary arteries main source of right atrial myxoma appears.
symptom complex caused by impaired blood flow in intracavitary myxoma occurs in a situation where the substrate is completely occlusive tumor atrioventricular hole and the mouth of the pulmonary trunk.The consequence of these pathological changes is the emergence of persistent signs of increased intravascular pressure in the pulmonary vessels, accompanied by severe hemodynamic and respiratory disorders in the form of increasing shortness of breath, dry cough, hoarse with sputum containing an admixture of blood, severe peripheral edema syndrome, and cardiac arrhythmias.Pathognomonic signs myxoma in this situation is a significant improvement of the patient in a horizontal position of the body when clinical manifestations may disappear on their own and then appear at the change of position of the body in a vertical position.
characteristic manifestations of right heart myxoma is the emergence of generalized swelling and accumulation of fluid in the abdomen, pelvis and between the pleural sheets, hepatosplenomegaly, and cyanosis of the skin with a primary lesion of the distal parts of the body.Unfortunately, all of these signs appear at a late stage of the disease when the tumor substrate parameters reach high values.In view of the similarity of the clinical manifestations of myxoma of the right atrium with symptoms of mitral stenosis, the patient is required to be tested for the presence of valvular lesions.Myxoma localized in the ventricular cavity, rarely seen in general clinical symptoms and more accompanied by signs cardiohemodynamic violations.
objective examination of the patient using auscultation techniques, unfortunately, does not allow to establish the correct diagnosis even with the presence of the characteristic features (splitting the first tone, systolic murmur at the apex of the heart, the sound of mitral regurgitation).All these symptoms can occur in other diseases of the heart, for example, valvular, so they can not be considered specific features of myxoma.
Standard electrocardiographic examination of the patient is adequate to establish the fact of myxomatous changes in a particular area of the heart, and when performing fluoroscopic examination of the chest revealed only a slight change in the configuration of the heart in an "mitralizatsii."Only in a situation of long-term course of the disease, accompanied by the formation of many calcifications can be determined indirectly radiological signs of myxoma.
most informative and accessible imaging technique myxoma is echocardioscopy transthoracic access, allowing to determine the location, size, shape of a tumor, its relation with other structures of the heart.The distinctive characteristics of myxoma is its massive vascularization, which is easy to recognize when you use duplex scanning of the heart.
treatment of any location myxoma is extremely operationally its removal, and radical surgery for myxoma resection implies full intracavitary tumor substrate.It is preferred to carry out the surgical removal of myxomatous site immediately after its detection, since the risk of long-term complications of this disease is great.When procrastination in the application of myxoma surgery within two years the patient may develop a fatal disease caused by a cerebral embolism and major coronary arteries.
for excision of myxoma surgeons prefer to use the median longitudinal sternotomichesky access, allowing adequately visualize the affected area.Removal myxomatous tumor should be maximized, embracing not only the tumor substrate and surrounding tissue.After removal of the tumors, in the atrial septal defect is formed by a wound, which is used to remove the plastic excised portion of the pericardium.The appearance of signs of relapse of the disease in the late postoperative period indicates a violation of technology implementation myxoma removal, whereby a portion of the substrate of the tumor was not excised.When studying the remote Myxoma it can have both soft tissue and a dense structure with a smooth surface of various sizes and shapes.
Removing myxomatous tumor as possible should be carried out carefully, as during surgery increases the risk of tumor embolism substrate.For this purpose, the operational step is eliminated manual finger audit and before the plastics defect resort to careful washing diseased atrial cavity to visualize any residual tumor.In a situation where myxoma accompanied by damage to cardiac valves, cardiac surgeons prefer to simultaneously carry out the removal of the tumor and perform myxomatous prosthetic valve affected.