左房粘液腫の心エコー図所見と臨床所見ならびに組織学的所見の比較検討
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概要
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The purpose of this study was to compare the symptoms, clinical features, laboratory findings and echocardiographic findings in patients (pts) with left atrial myxoma and the histological and operative findings. The subjects consisted of 40 pts admitted to our hospital between 1978 to 1995. In regard to clinical findings, we checked for atrial fibrillation, embolism, pulmonary hypertension (PH) and congestive heart failure (CHF), and as echocardiographic findings, investigated the size of the tumor, the appearance of the tumor-surface (smooth or irregular), the occurrence of prolapse, characteristics (homogeneous or unhomogeneous), and the degree of movement. The pts with an irregular-surfaced myxoma on echocardiography had a higher risk of embolism than the pts with a smooth-surfaced myxoma (8/9: 89% vs 1/13: 8%). The pts with prolapsing and smooth-surfaced myxoma had a higher rate of occurrence of CHF and PH than the pts with the non-prolapsing myxoma (9/13: 69% vs 0/9: 0%). The results of histological examination showed that the smooth-surfaced myxomas were covered with fibrous tissue, whereas irregular-surfaced myxomas were covered with thrombus, gelatinous myxoid matrix and myxoma cells. Therefore, the pts with an irregular-surfaced myxoma were diagnosed on the basis of an embolism before the occurrence of CHF and PH, and the pts with the prolapsing and smooth-surfaced myxoma were diagnosed on the basis of CHF and PH without the occurrence of embolism. Comparison of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in the diagnosis of left atrial myxoma showed that the stalk of myxoma was detected clearly in all pts by TEE, but only detected in 3/13 pts (23%) by TTE. The entire myxoma was not detected on the same TEE section in patients with giant tumor. Therefore, a comprehensive and clear understanding of left atrial myxoma can be obtained by using TTE plus TEE. In conclusion, it is possible to infer the clinical features, clinical course and histological findings in pts with atrial myxoma based on the echocardiographic findings.
- 東京女子医科大学の論文
- 1996-10-25
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