UNASSIGNED: A 66-year-old female with known metastatic adenocarcinoma of the lung, and chronic obstructive pulmonary disease presented with acute onset shortness of breath for two days. The patient experienced respiratory arrest en-route to the hospital and required intubation. Computed tomography angiography (CTA) of the chest revealed a new 1.4 × 1.6 cm intracardiac mass along the pulmonary valve. Further evaluation with cardiac magnetic resonance imaging revealed it to be a large vascular tumor on the ventricular side of the pulmonary valve, attached with a narrow stalk. Due to high surgical risk, the patient underwent transesophageal echocardiographic guided percutaneous removal of the mass. Pathology confirmed the mass to be a myxoma.
UNASSIGNED: Atypical myxoma should be considered in the differential diagnosis of valvular masses. Percutaneous resection of valvular masses may be feasible in high-risk surgical patients.
CONCLUSIONS: Pulmonary valve myxoma is a rare condition and the literature on the characteristics and treatment options for pulmonary valve myxoma is limited.Our patient was treated with a minimally invasive treatment approach: removal of a tumor with intra operative transesophageal echocardiographic guidance using AngioVac and Flow Triever catheters.Percutaneous resection of valvular masses may be feasible in high surgical risk patients.
■一名66岁女性,患有已知的肺转移性腺癌,和慢性阻塞性肺疾病表现为急性发作的呼吸急促两天。患者在去医院的途中经历了呼吸骤停并需要插管。胸部计算机断层扫描血管造影(CTA)显示沿肺动脉瓣有一个新的1.4×1.6cm的心内肿块。心脏磁共振成像的进一步评估显示它是肺动脉瓣心室侧的大血管肿瘤,附有狭窄的茎。由于手术风险高,患者接受了经食管超声心动图引导经皮切除肿块.病理证实肿块为粘液瘤。
■瓣膜肿块的鉴别诊断应考虑非典型粘液瘤。对于高危手术患者,经皮瓣膜肿块切除术可能是可行的。
结论:肺动脉瓣粘液瘤是一种罕见的疾病,关于肺动脉瓣粘液瘤的特征和治疗选择的文献有限。我们的患者接受了微创治疗方法的治疗:使用AngioVac和FlowTriever导管在术中经食管超声心动图引导下切除肿瘤。对于高手术风险的患者,经皮瓣膜肿块切除术可能是可行的。