Multidisciplinary Approach to Right Ventricular Myxoma

Abstract Right ventricular (RV) myxoma that obstructs the RV outflow tract is rare. Multimodality imaging is crucial due to the curved and triangular shape of the RV anatomy. Incomplete resection by the right atrial approach in cardiac myxomas may be prevented by preoperative imaging with echocardiography, computed tomography and magnetic resonance imaging to provide detailed visualization. Right ventriculotomy may be an alternative approach to the isolated atrial approach to get complete resection of RV myxoma in suitable patients. The preferred surgical treatment is not well defined for ventricular myxomas and careful preoperative planning is essential. Surgical resection should be performed as soon as possible to avoid outflow tract obstruction, which might result in sudden death. The collaboration between cardiologist and heart surgeon and the effective use of imaging tools are essential for successful treatment. In this article, diagnosis and treatment and the heart team approach to RV myxoma are discussed with a demonstrative patient.

摘要 阻塞右心室流出道的右心室黏液瘤（Right ventricular myxoma，RV）较为罕见。由于右心室解剖结构呈弯曲的三角形形态，多模态成像（multimodality imaging）在该病的诊疗中至关重要。通过术前采用超声心动图、计算机断层扫描（computed tomography，CT）与磁共振成像（magnetic resonance imaging，MRI）进行详细显像，可避免经右心房入路切除心脏黏液瘤时出现切除不完全的问题。对于适宜患者，右心室切开术可作为单一心房入路之外的备选术式，以实现右心室黏液瘤的完整切除。针对心室黏液瘤的首选手术治疗方案尚未明确，因此细致的术前规划必不可少。应尽快实施手术切除，以避免流出道梗阻引发的猝死风险。心脏病学家与心脏外科医师的协作，以及影像学工具的合理应用，是治疗成功的关键。本文结合一例示范病例，对右心室黏液瘤的诊断、治疗及心脏团队诊疗模式进行了探讨。