Diagnosticul şi tratamentul chirurgical al tumorilor cardiace

Abstract

Introducere: Cu toate că tumorile cardiace se întâlnesc destul de rar, diagnosticul precoce stabilit ne oferă posibilitatea de a efectua un tratament chirurgical radical şi eficace. Material şi metode: Au fost analizate protocoalele intervenţiilor chirurgicale la 86 de pacienţi cu tumori cardiace, care s-au tratat pe parcursul anilor 1983-2014 (primele 6 luni), vârsta bolnavilor a variat între 15-73 ani (media 53,7 ani). La 79 (91,8%) pacienţi tumorile au fost benigne şi la 7 (8,2%) – maligne. Rezultate: Diagnoza preoperatorie a fost stabilită analizând evoluţia simptomelor clinice şi rezultatele investigaţiilor instrumentale (ecocardiografia, CT, RMN). Morfologia tumorilor se prezintă în felul următor: mixoame – 71 de cazuri, rabdomioame – 2 cazuri, leiomioame – 2 cazuri, hemangiom – 1 caz, fibrom – 1 caz, mezoepitelioame – 2 cazuri, diferite sarcoame – 7 cazuri. Recidivă a mixomului atrial stâng s-a întâlnit la 2 pacienţi (2,8%), care au fost cu succes reoperaţi. Mortalitatea postoperatorie a constituit 8,2% (7 pacienţi), fapt care demonstrează eficacitatea tratamentului chirurgical. Concluzii: Tumorile cardiace primare trebuie înlăturate chirurgical. Vârsta pacienţilor şi severitatea insuficienţei cardiace nu poate servi ca contraindicaţie către operaţie. Tumorile cardiace maligne au un prognostic nefavorabil.

Introduction: Although cases of cardiac tumors are very rare, the early determined diagnosis gives us the possibility to perform an efficient and radical surgical treatment. Material and methods: The surgical records of 86 patients with cardiac tumors who were operated during 1983-2014 (first 6 months) were analyzed; patients age varies between 15-73 years (mean 53.7 years). In 79 (91.8%) patients the tumors were benign and in 7 (8.2%) cases – malignant.Results: Analyzing the evolution of clinical symptoms, the instrumental investigations results (echocardiography, CT, RMN) the preoperative diagnosis was determined. The morphology of the tumors were presented as follows: myxoma – 71 cases, rhabdomyoma – 2 cases, leiomyoma – 2 cases, hemangioma – 1 case, fibroids – 1 case, myoepithelioma – 2 cases, various sarcomas – 7 cases. Left atrial myxoma recurrence was determined in 2 patients (2.8%) who were successfully supposed to the repeated intervention. Postoperative mortality was 8.2 % (7 patients), that demonstrates the effectiveness of surgical treatment. Conclusions: The primary cardiac tumors should be removed in a surgical way. The patients' age and the severity of heart failure could not serve as a contraindication for surgery. Malignant cardiac tumors have a poor prognostic.