北京安贞医院冠心病外科中心科普号

治疗前 患者年龄小于50岁，冠脉多支病变，冠脉病变严重，为提高桥血管通畅率，改善生活质量，延长生存时间，降低心血管不良事件发生率。我们计划使用双乳内动脉，代替常规的大隐静脉，实施冠脉搭桥手术。 治疗后 治疗后30天 患者术后恢复良好，手术切口愈合良好

Cardiac Hemangioma at the Apex of the Right Ventricule: A Case Report and Literatures ReviewA 49-year-old man, without symptoms, was admitted to our hospital. A mass between right ventricle (RV) and pericardium was demonstrated on his chest computed tomography (Fig1A). Transthoracic echocardiography showed the mass located at the apex of RV, and there was no hemodynamic abnormality of right ventricular outflow tract obstruction. The mass adjacent to RV had a clear border:1px solid #000;"C" sourcevalue="1" hasspace="False" negative="False" numbertype="1" tcsc="0" w:st="on">1C). This patient recovered uneventfully, with no evidence of recurrence after 4months follow-up. The size of mass was 6.8 × 5.0 × 2.6 cm (Fig1D). Histologic diagnosis was hemangioma (Fig1E). Primary tumors and cysts of the heart and pericardium are rare, while only 2.8% of these tumors are cardiac hemangiomas [1]. Hemangiomas of the heart affect all ages, and may occur anywhere within the heart [2], and ventricular hemangiomas are extremely uncommon. In 45 reviewed cases of cardiac hemangioma, only 11 were located in the right ventricle [3]. Cardiac hemangiomas are vascular tumors, composed of capillaries or cavernous vascular channels, the majority of which are benign [4]. Surgery is the first choice of therapy in all patients with cardiac tumors [5]. To date, 30 cases of hemangiomas located in the right ventricle (including this one) have been reported in the literature. Table 1 shows the summary of preoperative data and details of surgical procedures of these cases. The most common sites were the anterior wall of the right ventricle in 20 patients (66.7%), including the apex of the right ventricle in 2 patients and the right ventricular outflow tract in 10 others (33.3%). To data, Sotoda reported the first cardiac hemangiomas at the apex of the RV in 2008, and our case is the second one.Operation was performed in all 30 patients. Cardiopulmonary bypass was used in 76.7% patients. Total resection of the tumor was done in 83.3% patients, 88% of which were with cardiopulmonary bypass. Surgical outcome and follow-up information were available for 23 patients, who were followed up for a period ranging between 6 months and 2 years, and all were alive and well. Especially for the cardiac hemangiomas locates in the anterior wall of the right ventricle, like our patient, the reconstruction of cardiac ventricle after the resection of the tumor, which is the same as the procedure after the resection of ventricular aneurysmectomy, is important, because heart failure can result from low cardiac output[5]. Owing to the reconstruction of the right ventricle, cardiac function was satisfactory in our case postoperatively.Considering all the things discussed above, we may safely make a conclusion that most cardiac hemangiomas in the right ventricle locates in the anterior wall of RV and this kind of patients should receive reconstruction of the ventricle after resection of the tumor with CPB, of which the longterm outcome seems satisfied and little recurrence was reported. References1. McAllister H. Tumors of the heart and pericardium. In: Silver MD, ed. Cardiovascular pathology. New York: Churchill Livingstone,1983:909– 43.2. Bizard C, et al. Cardiac hemangiomas. Ann Thorac Surg 1993; 56:390.3. Burke A, Virmani R. Tumors of the heart and great vessels. In: Atlas of tumor pathology. 3rd series, fascicle 16. Washington, DC: Armed Forces Institute of Pathology, 1995:80– 6.4. Van Trigt P III, Sabiston DC Jr. Tumors of the heart. In: Sabiston DC, Spencer FC. 6th ed. Philadelphia: WB Saunders; 1995. Surgery of the chest, Vol 2:p. 2069-86.5. A. Colli, et al. Recurrence of a right ventricular hemangioma. J Thorac Cardiovasc Surg. 2003 Sep;126(3):881-3.Figure legendsFigure 1. A: Computedtomography view shows there is a tumor in the right ventricle. B: After sternotomy, the tumor can be seen in the apex of the right ventricle. C: The reconstruction of the right ventricle after the resection of the tumor. D: Macroscopically view of the tumor: The size of the tumor was 6.8 × 5.0 × 65px. E: Microscopically view of the tumor (×200).(F, fiber trabecular; M, mass; P, graft patch; RV, right ventricle; S, sinusoids).