心原性脳梗塞治療4時間後に外科的切除を行った巨大左房粘液腫の1例

Surgery for a Massive Left Atrial Myxoma, Four Hours after a Thrombectomy for a Cerebral Embolism：Report of a Case

はじめに　左房粘液腫は心臓原発腫瘍の中ではもっとも頻度の高い良性腫瘍としてよく知られている．われわれは，心原性脳梗塞治療の4時間後に外科的切除を行った巨大左房粘液腫の1例を経験したので，至適手術時期に関する文献的考察を含めて報告する．

A 48-year-old female patient was transferred with dysarthria and left-sided hemiplegia. Contrast-enhanced computed tomography revealed occlusion of the first branch of the right middle cerebral artery, for which an emergency thrombectomy was successfully performed within 2 hours of patient’s initial symptoms. Postoperatively, transthoracic echocardiography revealed a massive mobile left atrial mass, measuring approximately 65×30 mm, a part of which moved in and out of the mitral valve without significant mitral regurgitation. Embolisms to the kidneys and the spleen were demonstrated. Another emergency cardiac surgery was performed, 4 hours after the thrombectomy, to resect the mass from the fossa oval with the atrial septum；the defect was closed using autologous pericardium. The histopathological findings of the specimen were consistent with a myxoma. The patient completely recovered and was discharged when ambulatory. We have discussed the importance of the timing of surgical intervention in the context of patients undergoing cardiac surgery after a cerebral embolism.