Cardiac papillary elastic fibroma
Introduction
Introduction to cardiac papillary elastoma The papillary elastoma is a primary benign cardiac tumor. The tumor occurs from the intima of the valve. The endocardial fibrous tissue, elastic fibers, smooth muscle cells and mucopolysaccharide matrix form the axis of the nipple. Hyperplastic endothelium cells, so called papillary elastoma. basic knowledge The proportion of illness: 0.001% Susceptible people: the elderly Mode of infection: non-infectious Complications: angina
Cause
Cause of cardiac papillary elastoma
Secondary wall thrombosis (30%):
In the past, the disease was described as a giant Lambert, which was recently thought to be based on mild endocardial injury, with fibrous deposition accompanied by secondary wall thrombosis.
Pathological anatomy (25%):
Papillary elastoma is usually small in size and sometimes difficult to distinguish from other cardiac tumors. It is often misdiagnosed as cardiac myxoma. Papillary elastoma occurs mostly in the heart valve and originates from the mitral atrial or aortic ventricular surface. The tumor is located in the middle of the valve leaflet, and has a certain distance from the free edge and the annulus. It can also occur in other heart valves or endocardial sites. The diameter of the tumor is mostly <1.5cm, and the largest one is up to 4.0cm. It has nipple-like leaflets, which are generally recognizable. The tumors are mostly gray-yellow, soft and brittle. They are usually single, but they can also be multiple, distributed on the endocardium of different parts. The histological examination shows papillary Lobular, a central portion of dense connective tissue that surrounds or is covered with proliferating endocardial tissue, similar to normal chordae tissue.
Pathology (25%):
Papillary-like angiofibroma is generally small in size, so it rarely causes extensive damage in the site, but because one or more small leaves of the tumor fall off or attach thrombus to cause embolism, systemic embolism is common, and the embolization site is mainly brain and coronary. Arterial, there are also reports of pulmonary embolism caused by papillary elastoma in the right heart system, or systemic embolism caused by the patent foramen ovale. In a few cases, due to the large tumor volume or the growth site, the heart valve function may cause stenosis or Close the performance of incomplete.
Prevention
Cardiac papillary elastoma prevention
1. The mechanism of the occurrence of cardiac papillary elastoma is not very clear. There is no specific preventive method at present, but to improve the understanding of this disease, early diagnosis and early treatment are the key to changing the prognosis of this disease.
2. Once the diagnosis of cardiac papillary elastoma, patients with surgical resection should be arranged for surgical treatment, because surgical resection can achieve the purpose of cure, for asymptomatic patients can prevent catastrophic embolic complications.
Complication
Cardiac papillary elastoma complications Complications
Complications such as angina pectoris and thromboembolism may occur. Individuals with congestive heart failure or low fever, often due to coronary artery embolism caused by angina pectoris, myocardial infarction, or cerebral embolism caused by transient ischemic attack, hemiplegia and other systemic embolism showed attention, a small number of patients can have auscultation Smell related heart murmurs or atrial fibrillation.
Symptom
Cardiac papillary elastoma symptoms Common symptoms Arrhythmia Heart murmur Myocardial infarction Coronary artery embolism Cerebral ischemia Angina low fever Heart failure
Clinical manifestations Most patients may have no obvious symptoms, very few with congestive heart failure or low fever, easily misdiagnosed as infective endocarditis, such patients often cause angina, myocardial infarction, or cerebral embolism due to coronary embolism Transient ischemic attack, hemiplegia and other systemic embolism have attracted attention. A small number of patients with cardiac auscultation can hear related heart murmurs or atrial fibrillation rhythm.
Examine
Examination of cardiac papillary elastoma
1. Can be diagnosed by two-dimensional echocardiography.
2. Transesophageal two-dimensional or color Doppler echocardiography can be confirmed. Doppler Echocardiography There are many red blood cells in the blood, which can reflect and scatter ultrasound, which can be considered as a tiny sound source. The probe is placed in the rib gap and emits ultrasonic waves. When red blood cells flow in the heart or large blood vessels, the sound of red blood cell scattering changes. When the red blood cells move toward the probe, the reflected sound increases, and vice versa. The difference in the audio produced when the red blood cells move relative to the probe is called the Doppler shift. It shows the speed, direction and nature of blood flow. Doppler echocardiography is further divided into pulsed Doppler echocardiography, continuous wave Doppler echocardiography, and color Doppler echocardiography. The most widely used is pulsed Doppler echocardiography, which can trace the real-time Doppler spectrum of any blood flow in the heart in the case of two-dimensional image monitoring and positioning.
3. Endomysial myocardial biopsy can establish a diagnosis.
Diagnosis
Diagnosis and diagnosis of cardiac papillary elastoma
In addition to solving the patient's symptoms and signs, a valuable diagnostic method is two-dimensional echocardiography, transthoracic or transesophageal two-dimensional color flow Doppler echocardiography is more accurate, there are also authors through the endocardial myocardium Biopsy to establish a diagnosis, but the operation of obtaining tumor tissue is difficult, and may cause embolic complications, such as angina or myocardial infarction, coronary angiography can be used to understand coronary artery occlusion, surgical resection specimens histopathological examination is the final Deterministic diagnostic method.
In the diagnosis, attention should be paid to the identification of the giant Lamblia's scorpion, which can be found in 70% to 80% of heart disease patients, mainly composed of cellulose deposited on the contact edges of the heart valves. In particular, such neoplasms do not occur in the aortic surface of the semilunar valve, nor in the intimal surface of the cardiac wall, which is completely different from papillary fibroids.
