Cargando…
Perioperative management of intracardiac leiomyomatosis: An observational cohort study
Intracardiac leiomyomatosis (ICLM) is a rare condition in which the benign tumor extends into the right heart chambers through inferior vena cava. The best surgical approach still remains unclear. We present a retrospective cohort of 36 patients diagnosed with ICLM in Peking Union Medical College Ho...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5521905/ https://www.ncbi.nlm.nih.gov/pubmed/28723765 http://dx.doi.org/10.1097/MD.0000000000007522 |
_version_ | 1783252062337761280 |
---|---|
author | Xu, Jiaying Wei, Min Miao, Qi Zhu, Bin Yu, Chunhua Huang, Yuguang |
author_facet | Xu, Jiaying Wei, Min Miao, Qi Zhu, Bin Yu, Chunhua Huang, Yuguang |
author_sort | Xu, Jiaying |
collection | PubMed |
description | Intracardiac leiomyomatosis (ICLM) is a rare condition in which the benign tumor extends into the right heart chambers through inferior vena cava. The best surgical approach still remains unclear. We present a retrospective cohort of 36 patients diagnosed with ICLM in Peking Union Medical College Hospital between 2002 and 2016. The mean patient age was 44.5 (range 25–55) years. The clinical manifestations were various, including shortness of breath, chest tightness, edema of the lower extremities, palpitations, syncope, etc. Cardiac function of 30 patients (80%) remained mildly influenced, classified as New York Heart Association (NYHA) I-II. After careful preoperative evaluation, 19 patients underwent 1-stage operation while the other 17 patients underwent 2-stage operations. The original surgical plans were changed in 5 patients (14%) due to intraoperative transesophageal echocardiography (TEE) monitoring, with the tumor directly extracted through abdominal approach or right atrium without cardiopulmonary bypass and/or deep hypothermic circulatory arrest. Complete resection was achieved in 32 patients (89%). Despite increased volume of blood loss (P < .05), patients undergoing 1-stage operation had significantly shorter operation time, anesthesia time as well as hospital length of stay (P < .05), compared with 2-stage operations. The postoperative complication rates were not different between the 2 groups (P = .684). During mean follow-up time of 36.1 months, recurrence occurred in 7 patients (23%) but all are survived. Precise and full-scale preoperative evaluation of both the tumor anatomy and the patient's tolerability to the surgery should be performed. TEE plays a crucial role in guidance of surgical decision making, and 1-stage extraction of tumor through either abdominal approach or right atrium may be possible. |
format | Online Article Text |
id | pubmed-5521905 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-55219052017-07-31 Perioperative management of intracardiac leiomyomatosis: An observational cohort study Xu, Jiaying Wei, Min Miao, Qi Zhu, Bin Yu, Chunhua Huang, Yuguang Medicine (Baltimore) 3300 Intracardiac leiomyomatosis (ICLM) is a rare condition in which the benign tumor extends into the right heart chambers through inferior vena cava. The best surgical approach still remains unclear. We present a retrospective cohort of 36 patients diagnosed with ICLM in Peking Union Medical College Hospital between 2002 and 2016. The mean patient age was 44.5 (range 25–55) years. The clinical manifestations were various, including shortness of breath, chest tightness, edema of the lower extremities, palpitations, syncope, etc. Cardiac function of 30 patients (80%) remained mildly influenced, classified as New York Heart Association (NYHA) I-II. After careful preoperative evaluation, 19 patients underwent 1-stage operation while the other 17 patients underwent 2-stage operations. The original surgical plans were changed in 5 patients (14%) due to intraoperative transesophageal echocardiography (TEE) monitoring, with the tumor directly extracted through abdominal approach or right atrium without cardiopulmonary bypass and/or deep hypothermic circulatory arrest. Complete resection was achieved in 32 patients (89%). Despite increased volume of blood loss (P < .05), patients undergoing 1-stage operation had significantly shorter operation time, anesthesia time as well as hospital length of stay (P < .05), compared with 2-stage operations. The postoperative complication rates were not different between the 2 groups (P = .684). During mean follow-up time of 36.1 months, recurrence occurred in 7 patients (23%) but all are survived. Precise and full-scale preoperative evaluation of both the tumor anatomy and the patient's tolerability to the surgery should be performed. TEE plays a crucial role in guidance of surgical decision making, and 1-stage extraction of tumor through either abdominal approach or right atrium may be possible. Wolters Kluwer Health 2017-07-21 /pmc/articles/PMC5521905/ /pubmed/28723765 http://dx.doi.org/10.1097/MD.0000000000007522 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nd/4.0 This is an open access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0, which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author. http://creativecommons.org/licenses/by-nd/4.0 |
spellingShingle | 3300 Xu, Jiaying Wei, Min Miao, Qi Zhu, Bin Yu, Chunhua Huang, Yuguang Perioperative management of intracardiac leiomyomatosis: An observational cohort study |
title | Perioperative management of intracardiac leiomyomatosis: An observational cohort study |
title_full | Perioperative management of intracardiac leiomyomatosis: An observational cohort study |
title_fullStr | Perioperative management of intracardiac leiomyomatosis: An observational cohort study |
title_full_unstemmed | Perioperative management of intracardiac leiomyomatosis: An observational cohort study |
title_short | Perioperative management of intracardiac leiomyomatosis: An observational cohort study |
title_sort | perioperative management of intracardiac leiomyomatosis: an observational cohort study |
topic | 3300 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5521905/ https://www.ncbi.nlm.nih.gov/pubmed/28723765 http://dx.doi.org/10.1097/MD.0000000000007522 |
work_keys_str_mv | AT xujiaying perioperativemanagementofintracardiacleiomyomatosisanobservationalcohortstudy AT weimin perioperativemanagementofintracardiacleiomyomatosisanobservationalcohortstudy AT miaoqi perioperativemanagementofintracardiacleiomyomatosisanobservationalcohortstudy AT zhubin perioperativemanagementofintracardiacleiomyomatosisanobservationalcohortstudy AT yuchunhua perioperativemanagementofintracardiacleiomyomatosisanobservationalcohortstudy AT huangyuguang perioperativemanagementofintracardiacleiomyomatosisanobservationalcohortstudy |