Interv Akut Kardiol 2005; 4: 236-241

Koronarografické vyšetrenie po infarkte myokardu viedlo k diagnóze myxómu ľavej predsiene

Bihdan Lukáč1, Pavol Chňupa2
1 Interní oddělení Nemocnice Český Krumlov
2 Oddelenie neinvazívnej kardiológie, Slovenský ústav srdcových a cievnych chorôb, Bratislava

Úvod: Myxómy sú najčastejšie tumory srdca. Variabilný klinický obraz tvoria príznaky obštrukcie, embolizácie a celkové nešpecifické príznaky. Zriedkavou prvou manifestáciou môže byť aj akútny infarkt myokardu, ako popisujeme v kazuistike. Myxómy srdca môžu vytvárať neovaskularizácie, pozorovateľné pri koronarografii. Diagnostickou metódou voľby je transezofageálna echokardiografia (TEE). Chirurgická extirpácia je jedinou akceptovateľnou metódou liečby a je kuratívna. Opis prípadu: Päťdesiatsedemročná pacientka po prvom infarkte myokardu prednej steny bola vyšetrená koronarograficky. Nebola nájdená závažná stenóza či uzáver. Vedľajším nálezom bola nenápadná anomálna vaskularizácia napojená na dve vetvy pravej koronárnej tepny, ktorá vzbudila podozrenie na nádor v oblasti predsiení. Transtorakálne echokardiografické vyšetrenie bolo negatívne a neskôr nejednoznačné v dôkaze tumoróznej masy. Pomocou TEE bol diagnostikovaný a následne úspešne extirpovaný a histologicky verifikovaný pravý myxóm ľavej predsiene. Po 4 rokoch prekonala pacientka reinfarkt myokardu, koronarograficky opäť bez koronárnej stenózy nad 50 %, bez patologických vaskularizácií. TEE vylúčila recidívu myxómu srdca. Pacientka je po 5 rokoch sledovania bez klinických prejavov recidívy ochorenia.

Záver: Abnormálna koronárna vaskularizácia je detekovateľná pri koronarografii asi u polovice pacientov s myxómom srdca. Následné TEE vyšetrenie vedie k diagnóze a ku kuratívnej chirurgickej liečbe.

Klíčová slova: Kľúčová slova: koronarografia, myxóm srdca, myxóm predsiene, neovaskularizácia, patologická nádorová vaskularizácia, nádory srdca.

CORONARY ANGIOGRAPHY AFTER MYOCARDIAL INFARCTION LED TO DIAGNOSIS OF LEFT ATRIAL MYXOMA.

Introduction: Myxomas are the most frequent cardiac tumours. The variable clinical picture includes symptoms of obstruction, embolisations and nonspecific constitutional signs. Rarely, the first manifestation may also be acute myocardial infarction, as we describe in this case report. Myxomas can create neovascularisations, visible by coronary angiography. Transesophageal echocardiography (TEE) is the diagnostic procedure of choice. Therapy is surgical.

Case report: Coronary angiography after myocardial infarction very rarely arouses suspicion of cardiac myxoma. A 57-year-old female patient after first anterior myocardial infarction was evaluated by coronary angiography. No serious stenoses or occlusions were found. An accidental finding was abnormal vascularisation from two branches of the right coronary artery (RCA) which led to the suspicion of tumour in the atria. First transthoracic echocardiography was negative and subsequent echocardiography yielded a doubtful result. TEE revealed left atrial myxoma. After successful surgical removal diagnosis of true myxoma was verified. Four years later, the patient underwent myocardial reinfarction. Coronary angiography revealed no serious coronary stenosis over 50 %. No abnormal vascularisations were seen. Transesophageal echocardiography ruled out recurrence of cardiac myxoma.

Conclusion: Abnormal coronary vascularisations are visible on coronary angiography in about 50 % of patients with cardiac myxoma. Subsequent transesophageal echocardiography leads to diagnosis and to curative surgical treatment.

Keywords: Key words: coronary angiography, cardiac myxoma, atrial myxoma, neovascularisation, pathologic tumor vascularisation, cardiac tumors, transesophageal echocardiography.

Zveřejněno: 1. leden 2006


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