Volodymyr Isaienko
National University of Health Care, Ukraine
Title: Surgical correction of valve lesions in Heart Myxomas
Biography
Biography: Volodymyr Isaienko
Abstract
The frequency of detection of heart tumors in cardiosurgical clinics ranges from 0.09% to 1.9% of the total number of hospitalized patients. Myxomas account for up to 75% of cardiac tumors. The growth of cardiac myxomas (CM) may be accompanied by damage to the valvular structures of a different nature.
The aim of the study is to determine the frequency, mechanism of valve damage in cardiac myxomas (CM), and methods for their correction.
Material and methods. In the N.M. Amosov National Institute of Cardio-Vascular Surgery of the NAMS of Ukraine for the period from 1.01.1969 to 01.01.2022 984 consecutive interventions for primary heart tumors were performed. Cardiac myxomas (CM) were found in 876 (89%), of which in 764 (87,2%) cases - CM of the left atrium (LA). The age of patients with HM was 3 to 79 years (on average 47,5 ± 3,4 years). The 631 of these (72,7%) aged 31 to 60 years. The number of female was 642 (73,9%).
Nonmixomatous benign heart tumors were observed in 39 (3,9%) cases, malignant tumors of the heart - in 69 (7,0%).
Surgical correction of valvular lesions at CM was performed in 57 (6,6%) patients. In 22 (38,6%) cases isolated mitral valve (MV) lesion was observed, in 32 (57,1%) - tricuspid valve (TV), in 2 (3,5%) cases - aortic valve (AV) lesion, in 1 case (1,8%) - a combination of mitral and aortic valve lesions, in 18 (31.6%) cases - lesions of the mitral and tricuspid valves. Among them, mechanical damage to valvular structures by the tumor was detected in 29 (50,9%) patients. Involvement of the valvular apparatus in the tumor process was observed in 10 (17,6%) patients. In 1 (1.8%) patient, myxoma of right ventriÑle was attached to the papillary muscles and chords of the TV, in 9 (15.8%) cases of LA myxoma affected the mitral valve leaflets. Surgical correction of valvular lesions was performed in 67 (7.7%) patients: in 14 (1.6%) cases - prosthetic valves (9 - MV, 1 - TV, 3 - AV, 1 - AV + MV), in 43 (4.9%) - plastic surgery with a positive functional effect, and in 9 (1.0%) cases, isolated removal of the tumor from the valvular apparatus was performed.
Results. Hospital mortality over the past 20 years was 0% in the surgical treatment of CM, ie 520 operations were performed without fatalities. However, it should be noted that by 2000, at the time of formation of tactics for surgical treatment of CM, hospital mortality was 4.6% (39 cases).
Survival in the period up to 20 years was 79.8%. In the follow up period in I f.k. NYHA was 584 (78.3%) patients, in II f.k. - 118 (14.8%). Recurrences of CM were found in 18 (2.1%) patients between 2 and 12 years (mean 3.5 ± 0.4 years) after primary surgery.
Repeated surgery after correction of valvular lesions in CM was required in 1 patient (1.8%).
Conclusion. Correction of valvular lesions in the treatment of cardiac mixomas allows to achieve radical surgery and good immediate and long-term results. In the follow up period EchoCG control of valve structures is necessary, after their correction at removal of a heart tumors02000, Amosova street, 6, Kyiv, Amosov National Institute of Cardio-Vascular surgery of the Academy of Medical Sciences of Ukraine, Ukraine.