ObjectiveTo summarize the pathological characteristics of primary left ventricular tumors and their influence on surgical treatment.MethodsThe clinical data of 32 patients with primary left ventricular tumor in Fuwai Hospital from January 2008 to March 2019 were retrospectively analyzed, including 17 males and 15 females with an average age of 33.88±17.89 years. The impact of different types of left ventricular tumor pathology on the surgical outcome was analyzed.ResultsThirty-two patients with primary left ventricular tumors underwent surgery. Postoperative pathological biopsy results revealed benign tumor in 31 patients, including myxoma in 10 patients, lipomas in 7 patients, fibroma in 4 patients, hemangioma in 3 patients, rhabdomyoma in 2 patients, cyst in 2 patients, schwannoma in 1 patient, papillary fibroelastoma in 1 patient, cavernous hyperplasia of valvular lymphatic vessels in 1 patient. There was 1 patient of carcinoid (low-grade malignant tumor). Thirty patients underwent tumor resection surgery under hypothermic anesthesia and cardiopulmonary bypass followed by cardiac arrest while 2 patients without cardiopulmonary bypass. Nine patients received partial resection of the tumor, including lipomas in 6 patients, rhabdomyoma in 2 patients, schwannoma in 1 patient. Twenty-three patients received complete resection of the tumor. There were no in-hospital deaths, bleeding, secondary thoracotomy, low cardiac output, renal failure, postoperative embolism or other surgical complications. All the patients were normal before they were discharged out of the hospital. Their average postoperative hospital stay was 8.1±2.7 d. Within 6 months after the surgery, all 32 patients returned to the hospital for reexamination, and ultrasound results were all normal. Afterwards, the patients were followed up by telephone or in an outpatient clinic, and 3 patients were lost. The follow-up rate was 90.63%. During the follow-up of 3-120 (61.4±38.5) months, among the 9 patients whose tumors were partially resection, 2 patients recurred. One patient with schwannoma recurred 30 months after the surgery, and in the other patient lipomas grew 15 months later which resulted in massive regurgitation of the mitral valve.ConclusionSurgical resection is the first choice for the treatment of left ventricular benign tumors. For malignant left ventricular tumors, it is necessary to be cautious, and the surgical risk needs to be carefully evaluated. Most of the primary left ventricular tumors need to be operated as soon as possible. A surgeon should develop different surgical strategies according to different pathological types of tumors.
Objective To evaluate the clinical and follow-up results of the surgical treatment for hypertrophic obstructive cardiomyopathy associated with aortic stenosis. Methods We retrospectively analyzed the clinical data of the patients with hypertrophic obstructive cardiomyopathy plus aortic stenosis in our hospital from February 2008 to October 2015. There were 4 males and 3 females aged 55.6 ± 7.5 years. All the patients were received concomitant aortic valvulopasty at the time of modified extended Morrow procedure. Echocardiographic data and major complications were recorded through the outpatient clinic and telephone. Results The postoperative ventricular septal thickness, left ventricular outflow tract gradient and aortic gradient were significantly lower than those in preoperation with statistical differences (P<0.05). During the mean follow-up 25.6 ± 28.2 months period, 1 patient died of cerebral hemorrhage, 1 patient was implanted a permanent pacemaker, and 1 patient had a postoperative new-onset atrial fibrillation. All patients had a satisfied prosthetic valve function and the left ventricular outflow tract gradient. The patient's symptoms and heart function significantly improved postoperatively. Conclusion For patients with hypertrophic obstructive cardiomyopathy associated with moderate to severe aortic stenosis, concomitant aortic valvulopasty at the time of modified extended Morrow procedure is an appropriate and effective treatment, which can significantly alleviate the clinical symptoms, and improve quality of life with a satisfied prognosis.
ObjectiveTo summarize the age distribution of different pathological types of primary left ventricular tumor and its influence on preoperative diagnosis, surgical methods and therapeutic effect.Methods The clinical data of 35 patients with primary left ventricular tumor admitted to Fuwai Hospital of Chinese Academy of Medical Sciences from January 2008 to March 2019 were retrospectively analyzed. There were 19 males and 16 females with an average age of 33.81±17.56 years. According to the age, the patients were divided into an infant group (less than 7 years), an adolescent group (7-17 years), a young group (18-44 years), a middle-aged group (45-59 years) and an elderly group (over 60 years). The age distribution characteristics of different pathological types of tumor patients were analyzed, and the influence on surgical methods, short-term and long-term curative effect of surgery in different age groups was analyzed. Within 6 months after the operation, the patients returned to the hospital to review the echocardiography, and then were followed up by telephone.Results Of the 35 patients with primary left ventricular tumor, only 1 patient in the middle-aged group had low malignancy carcinoid tumor, and the others were benign tumors. Fibroma and rhabdomyoma accounted for the majority of the infant group and adolescent group. Myxoma was the common tumor in the young group, middle-aged group and elderly group, followed by lipoma. Thirty-three patients were operated under general anesthesia, hypothermia and cardiopulmonary bypass (CPB). Two patients with epicardial lipoma underwent normothermic surgery without CPB. Nine patients underwent partial resection of left ventricular tumors, and 26 patients received complete resection of left ventricular tumor. There was no hospital death, opening stanching, secondary thoracotomy, low cardiac output, embolism or other complications. The postoperative hospital stay was 7.97±2.56 days, and the postoperative reexamination was normal. Subsequently, 35 patients were followed up by telephone or outpatient service. The average follow-up time was 59.87±37.62 months. In the young group, 2 patients with partial resection recurred.Conclusion Surgical resection is the first choice for the treatment of left ventricular benign tumor, and it is safe. The principle of left ventricular tumor surgery is to protect the function of ventricle and valve, prevent damage to the conduction system, and remove the tumor as completely as possible.