心脏黏液瘤患者的瓣膜功能障碍:损害机制和矫正方法

R. M. Vitovskyi, V. Isaienko, D. Dyadyun, I. Martyshchenko, O. Pishchurin, O.V. Kupchinsky
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摘要

目的分析心脏黏液瘤瓣膜病变的频率和性质,评价手术矫正受损伤瓣膜的效果。材料和方法。在1969年1月1日至2020年10月1日的单中心研究中,观察了962例形态学证实的原发性心脏肿瘤患者。856例(89.0%)患者发现心脏黏液瘤。70例(8.1%)患者合并心脏黏液瘤并发瓣膜装置病变。瓣膜损伤的体积和性质不同,取决于黏液瘤的大小、稠度和定位、移动性的程度以及肿瘤上明显的纤维化和钙化区域的存在。结果。手术矫正瓣膜结构病变65例。在5例患者中,可以从瓣膜装置中切除肿瘤组织,然后在不损害瓣膜和瓣下结构的情况下预防疾病复发。手术技术包括整形手术和瓣膜置换术。这类患者术后长期的特点包括进行性瓣膜功能障碍,表现为瓣膜装置进一步变形导致功能不全的进展。结论。在清除黏液瘤的同时,有必要对瓣膜进行彻底检查,并根据损伤的性质和严重程度,通过各种方法矫正瓣膜损伤,包括整形手术和瓣膜置换术。关键词:心脏肿瘤,黏液瘤,瓣膜结构,手术治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Valve dysfunction in patients with cardiac myxomas: mechanism of damage and methods of correction
The aim – to analyze the frequency and nature of lesions of the valve apparatus, to evaluate the results of surgical correction of the affected valves in heart myxomas. Materials and methods. In one-centre study, during period from 01.01.1969 to 01.10.2020, 962 patients with morphologically verified primary heart tumors were observed. Myxomas of the heart were found in 856 (89.0 %) patients. The pathology of the valve apparatus in combination with cardiac myxomas was noted in 70 (8.1 %) patients. The volume and nature of valve damage differed and depended on size, consistency and localization of myxoma, the degree of its mobility, and the presence of areas of pronounced fibrosis and calcification on the tumor. Results. Surgical correction of lesions of valve structures was performed in 65 patients. In 5 patients, it was possible to remove tumor tissue from the valve apparatus, followed by prevention of disease recurrence without damaging valve and subvalvular structures. Surgical techniques included both plastic manipulation and valve replacement. The features of the long-term postoperative period in such patients include progressive valve dysfunction manifested by the progression of insufficiency due to further deformation of the valve apparatus. Conclusions. Alongside with myxoma removal, it is necessary to conduct a thorough examination of the valve apparatus and correction of valve damage by various methods, including plastic surgery and valve replacement, depending on the nature and severity of the damage. Key words: cardiac tumors, myxoma, valve structures, surgical treatment.
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