Diagnosis and surgical treatment of heart valve non-mixoma tumors

Abstract

Aim. To study the clinical, diagnostic, surgical and morphological features of non-mixoma primary tumors of the heart valves, the possibilities of their early diagnosis and to develop an optimal surgical approach. Methods. The surgical treatment of 331 patients with tumors of the heart was analysed, of which 45 (13.6%) were radically distant primary tumors of the heart valves including 33 (73.3%) myxoma and 12 (26.7%) non-myxoma tumors. Among considered in this study 12 non-myxoma tumors 9 cases were papillary fibroelastoma, 1 - neurolemmoma, 1 - lipoma, 1 - fibroma. Results. The leading non-invasive preoperative diagnostic procedures for non-myxoma primary tumors of the heart valves were transthoracic and transoesophageal echocardiographic studies, the sensitivity of which were 91.7 and 100% respectively. In unclear cases, a computer and magnetic resonance imaging were used. Additionally, electrocardiography, phonocardiography, radiological methods were performed, clinical and biochemical blood tests were analysed. Intraoperative revision and morphological verification ensures the establishment of tumors final clinical diagnosis. Patients with non-myxoma tumors of the heart valves had polymorphic symptomatic picture which included circulatory failure, false angina, arrhythmias, clinical signs imitating heart defects, embolic syndrome, dizziness and/or syncope, causeless fever. Surgical removal of the 12 non-myxoma tumor was performed by cardiopulmonary bypass and pharmacological cold cardioplegia, in 4 cases, the intervention combined with the replacement of the affected valves by artificial prostheses, in 1 case - coronary artery bypass grafting. Hospital mortality of patients was zero. Quality of life of operated patients was rated as good in 9 (75%) patients, satisfactory - in 2 (16.7%), unsatisfactory - in 1 (8.3%) patients, which was due to the death of the patient 13 months after removal of neurolemmoma in connection with multiple metastasis in the brain and spinal cord. Conclusion. Timely surgical intervention helped to stabilize the functional state of the patients, to create a favorable prognosis to improve the quality of life and increase its length.

Keywords

non-myxoma tumor of the heart / heart valves / diagnostics / comprehensive echocardiography / surgical treatment

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RIGHTS & PERMISSIONS

Kiprenskiy A.Y., Nechayenko M.A., Kuznetsova L.M., Fyodorov D.N.