Left atrial myxoma resection

After the diagnosis of left atrial myxoma, in order to improve symptoms and avoid serious complications, tumor resection should be performed in time. If the patient has fever, increased erythrocyte sedimentation rate, and weakened whole body, the subacute bacterial endocarditis and rheumatic valvular disease should be excluded after examination. It should also be operated without waiting, so as to prevent the disease from further worsening. About 8% of patients with cardiac myxoma have reportedly died while awaiting surgery. Of the 112 patients with cardiac myxoma who were treated in Changhai Hospital in the past 10 years, 8 underwent emergency surgery, and none of them died while waiting for surgery. Treatment of diseases: myxoma in the heart Indication 1. After the diagnosis of left atrial myxoma, in order to improve symptoms and avoid serious complications, tumor resection should be performed in time. If the patient has fever, increased erythrocyte sedimentation rate, and weakened whole body, the subacute bacterial endocarditis and rheumatic valvular disease should be excluded after examination. It should also be operated without waiting, so as to prevent the disease from further worsening. About 8% of patients with cardiac myxoma have reportedly died while awaiting surgery. Of the 112 patients with cardiac myxoma who were treated in Changhai Hospital in the past 10 years, 8 underwent emergency surgery, and none of them died while waiting for surgery. 2. The tumor partially blocks the mitral valve orifice, causing acute heart failure and acute pulmonary edema. If the condition is not well treated, the tracheal intubation assisted breathing should be performed immediately, and emergency surgery should be performed. 3. The mucinous tumor fragments fall off, causing embolism of the cerebral blood vessels or peripheral blood vessels. When hemiplegia or limb embolism occurs, after active treatment, the patient should be conscious and the disease should be stable. Contraindications 1. Myxoma patients with severe valvular obstruction, sudden cardiac arrest and fulminant pulmonary edema, can not recover after active rescue of the heart, the patient is in a deep coma. 2. Myxoma has multiple cerebral embolism and embolism of vital organs around the patient. The patient is in extreme exhaustion, and has liver and kidney dysfunction, or has lost the opportunity for surgical treatment during gastrointestinal bleeding. Preoperative preparation 1. Eliminate all infected lesions. 2. Correct malnutrition, anemia, and liver, kidney, and other organ dysfunction. 3. Correct heart failure or put the patient in the best possible condition. 4. Stop the digitalis and diuretics 48 hours before surgery. 5. Use an ordinary diet 1 week before surgery to adjust the electrolyte balance. If the patient takes long-term diuretics, the oral potassium chloride should be increased in the first week before surgery to overcome the deficiency of potassium in the body. 6. Start antibiotics with antibiotics on the 3rd day before surgery. Give a dose of antibiotics when you use the medicine before surgery. 7. In severe cases, glucose, insulin and potassium chloride solution (gik) were intravenously administered 1 week before surgery to protect the myocardium. 8. Psychotherapy should be performed on patients before surgery to eliminate concerns and enhance cooperation between doctors and patients. Let the patient understand the various situations that may occur during the operation to facilitate the patient's active cooperation. Surgical procedure 1. Incision: The median incision of the sternum. Cut the happy bag in the vertical. Establish extracorporeal circulation. 2. Cut the left atrium longitudinally behind the chamber ditch to reveal myxoma. 3. The tumor pedicle at the interatrial septum is removed along with the tumor. The tumor pedicle should be removed first and then the tumor removed carefully. Rinse the heart chamber repeatedly with a large amount of physiological saline to avoid embolization or planting caused by residual tumor tissue. The atrial septal tissue around the attachment of the tumor pedicle was excised in a range of 1 cm in diameter to prevent local recurrence. 4. Intermittent "8" word sutured atrial septal defect. If the defect is large, apply the patch method to repair it. 5. Stitch the left atrium incision. complication 1. Embolization: The main cause of embolization in myxoma resection is excessive movement and squeezing of the heart during exploration, or when the extracorporeal circulation is intubated, causing the tumor fragments to fall off; when the tumor is removed, the tumor is broken and the tumor is broken. . If the above situation occurs, the left and right heart chambers should be washed repeatedly to prevent the tumor fragments from being hidden in the ventricular trabeculae of the ventricle. After rinsing, the lungs should be urged to overflow the blood from the lungs and veins, so that fragments that may fall into the pulmonary blood vessels flow out with the blood, and then the aortic occlusion forceps are temporarily released, so that the blood flows back into the left ventricle and then blocks. Broken aortic forceps for flushing. The embolization of tumor fragments is more common in the cerebral blood vessels, but also in other parts of the blood vessels. Early postoperative performance is the patient's unconsciousness, convulsions, and signs of hemiplegia and aphasia. The main treatment methods are the use of head cooling, diuretic dehydration, application of mannitol to reduce intracranial pressure and other measures to enable patients to survive the dangerous period and promote rehabilitation. However, the prognosis is poor, and most patients have different degrees of hemiplegia. Other large arterial embolizations can be surgically removed after the diagnosis is confirmed. 2. Acute heart failure: After removal of cardiac myxoma, the mitral valve obstruction is relieved. Because of the better compensatory function of the myocardium, there is less chance of postoperative heart failure. The main reason for this complication is the lack of understanding of the pathophysiological characteristics of the disease. In the short term, the liquid supplementation, especially the colloidal fluid, is too fast, causing the volume load to increase, causing acute left heart failure. In severe cases, it can be complicated. Acute pulmonary edema. The main treatment measures are intravenous injection of gerberin and furosemide, intravenous infusion of dopamine or dobutamine, which enhances myocardial contractile function; rapid diuretic dehydration and reduced cardiac capacity load. Application of vasodilator drugs such as sodium nitroprusside, reduce the pressure load, use positive end-expiratory pressure to assist breathing, reduce alveolar interstitial edema, enhance the diffuse function of alveoli, avoid hypoxia and aggravate heart failure. 3. Arrhythmia: According to the literature, the most common complications after cardiac myxoma are arrhythmias, such as frequent premature atrial contractions, supraventricular tachycardia, atrial fibrillation and conduction block, which may be related to atrial incision and resection. Part of the room interval is related. This type of arrhythmia is usually transient. If it does not affect hemodynamics, it can be left untreated. If there are obvious symptoms and hemodynamic changes, it can be treated according to the situation. The supraventricular tachycardia can be applied to Vera. Paomi's slow intravenous injection controls the heart rate at 100-120 beats/min. Cardiac bradycardia can be intravenously infused with isoproterenol, and the heart rate is increased to 70-80 beats/mm. According to reports in the literature, II and III degree conduction block can sometimes occur. Epicardial temporary cardiac pacing is used early in the operation. If the patient still cannot recover after 2 weeks, a permanent pacemaker should be installed.