intracardiac tumor resection

Intracardiac tumor resection is one of the important surgical methods for the treatment of intracardiac tumor enlargement and compression of cardiac blood supply. Treatment of diseases: primary cardiac tumors Indication Once the heart tumor is diagnosed, there are surgical indications. Due to the progression of the lesion and the risk of embolism, surgery should be performed as soon as possible. Patients with a history of occlusion of the valve orifice, syncope or embolism should be treated urgently. Preoperative preparation Complete preoperative routine examination as soon as possible. Proper diuretic treatment, correct water and electrolyte disorders, and improve nutritional status. Cardiac insufficiency requires treatment with a strong heart. Surgical procedure 1. After the left atrial myxoma is opened in the right atrium, it can be seen that the local interstitial tissue near the fossa ovalis has different degrees of dysplasia and hardening, such as the pedicle or the base of the tumor attached to the left part of the septum. . A traction line is sewn on the hardened atrial septal tissue, and the interatrial septum is cut into the left atrium cavity along both sides of the fossa ovalis. At the same time, pull the traction line and expand the incision to the side ends along the healthy interatrial septum. When the tumor pedicle stuck to the interatrial septum is pulled out of the left atrium by the traction line, a small spoon is placed along the side of the tumor into the left atrium cavity, and the entire tumor is lifted out of the heart chamber. The range of general atrial septal resection should include the entire fossa ovalis and the atrial septum and endocardial tissue attached to the tumor. The extent of resection should be large to avoid local recurrence of the tumor. The defect on the room compartment is often repaired with polyester sheets or autologous pericardial tablets. The myxoma that is larger or attached to the left atrial wall is often deep in the left atrium, so it is not easy to remove through the right atrium and interatrial incision, so a left atrial incision should be used. The left atrium wall was cut at the parallel chamber groove in front of the right superior pulmonary vein. The atrial septal tissue was pulled down and trimmed around the tumor pedicle or attachment with scissors. Finally, part of the interatrial septum and the intact tumor were removed. The defect in the compartment can be directly sutured or repaired with a woven piece. 2. Giant left atrial myxoma The huge left atrial myxoma refers to the volume of myxoma > 5cm × 5cm × 5cm. If the attachment position of the tumor pedicle is not determined, the myxoma from the top of the left atrium cannot be excluded, or the patient is in a changed position, especially if the mitral valve obstruction occurs to the left side, and the left and right atrial joint incision must be performed. If the appearance of the tissue at the fossa ovalis is not fibrotic or hardened, and the tumor pedicle is not attached to the interatrial septum after the incision, the left and right atrium should be exposed by the hook or suture traction line. The cavity absorbs blood in the left atrium and explores the left atrium wall under direct vision. Pay special attention to the top of the left atrium. Myxoma pedicles, which generally originate from the left atrial wall, are extremely short. If the tumor is attached to the right posterior and posterior wall of the left atrium, it is better to expose the atrial endocardium around the tumor. The tumor can be completely removed because the local wall is thicker and extremely thick. There is little danger of piercing. If the tumor is attached to the top of the left atrium, close to the anterior border of the mitral valve, due to the deeper part, the exposure is poor, and it is often necessary to force the endothelium of the tumor and the root of the tumor to remove the tumor. Therefore, it is easy to damage the wall and hemorrhage. After the endocardial resection of the left atrium, the wall is weaker and more easily worn. After removal of the left atrial top tumor, the locally missing endocardium must be repaired. Take 4-0 non-invasive needles with small gaskets, suture with intermittent sutures, so that the endocardium is completely aligned, covering the rough wound surface. 3. Right atrial myxoma, after conventionally cutting the right atrial anterior wall, pay attention to the presence of other myxoma in the vicinity of the superior and inferior vena cava openings, right atrial ventricle and right ventricular cavity. If the tumor is attached to the interatrial septum, it is removed as in the aforementioned left atrial myxoma. Myxoma attached to the vicinity of the atrioventricular ring may damage the tricuspid valve leaflets and annulus when resected. A small number of tumors and valve leaflets are severely attached, and tricuspid valve replacement may be needed after resection. Right atrial tumor has a long tumor pedicle, often with the heart contraction movement into the upper and lower flaps to produce obstruction, and the annulus enlarges, the valve leaflet is not tight, therefore, sometimes need to do tricuspid valve after tumor removal Ring contraction. 4. Left ventricular myxoma is attached to the myxoma above the interventricular septum, very close to the aortic valve. The ascending aorta is blocked under cardiopulmonary bypass. A transverse incision is made in the aortic root to show a portion of the subpetal tumor. In order to further reveal the tumor and prevent the accidental injury of the semilunar valve during the resection, a traction line is sutured at the base of the tumor, the traction line is pulled, the endocardium in front of the tumor is cut, and the tumor is cut from the endocardium with scissors. The adhesion to the myocardium is removed and the tumor is removed. Some myxomas are located near the tip of the left ventricle, and the left ventricle is incision through the left apical avascular region. This incision is more likely to reveal the tumor, and it is easier to identify the site where the tumor is attached and the tumor with the papillary muscle and the mitral valve leaf. Relationship. If the tumor is not large, the left apical incision is more convenient. Large myxoma tissue in the left ventricular cavity often erodes into the trabecular muscle or deep into the trabecular muscle, and even spreads between the posterior mitral valve and the posterior wall, and the operation cannot be removed.

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