RESUMO
Inflammatory myofibroblastic tumor is a neoplasm with uncertain behavior. We describe a case in a 66-year-old female who underwent resection of a left atrial tumor suspected to be a cardiac myxoma which was subsequently diagnosed as an inflammatory myofibroblastic tumor. After three years' follow-up the patient underwent a second operation to remove tumoral occurrence in the right atrium, diagnosed as an intimal sarcoma. It cannot be confirmed whether the tumoral recurrence with a different diagnosis (intimal sarcoma) was a progression from the primary tumor or the metachronous appearance of a spontaneous sarcoma.
Assuntos
Apêndice Atrial , Neoplasias Cardíacas , Sarcoma , Feminino , Humanos , Idoso , Sarcoma/diagnóstico , Sarcoma/patologia , Sarcoma/cirurgia , Diagnóstico Diferencial , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgiaAssuntos
Fibroelastoma Papilar Cardíaco , Angiografia por Tomografia Computadorizada/métodos , Acidente Vascular Cerebral/etiologia , Afasia de Broca/etiologia , Fibroelastoma Papilar Cardíaco/diagnóstico por imagem , Fibroelastoma Papilar Cardíaco/cirurgia , Ecocardiografia Transesofagiana , Hemianopsia/etiologia , Hemiplegia/etiologia , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Aneurisma Coronário/complicações , Infarto Miocárdico de Parede Inferior/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Idoso , Angiografia por Tomografia Computadorizada , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/cirurgia , Angiografia Coronária/métodos , Ponte de Artéria Coronária , Feminino , Humanos , Infarto Miocárdico de Parede Inferior/diagnóstico por imagem , Infarto Miocárdico de Parede Inferior/cirurgia , Ligadura , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVES: The aim of this study was to evaluate outcomes in our department after surgery for obstructive hypertrophic cardiomyopathy and to establish the impact of a delay on the indication for surgery. METHODS: From January 1998 to February 2011, 69 patients with obstructive hypertrophic cardiomyopathy and left ventricular outflow tract obstruction at rest were operated on by the same team, and followed up for at least 1 year. We retrospectively analysed clinical data, echocardiography and ambulatory Holter electrocardiogram findings before surgery, early after surgery, at 3 months and annually at follow-up, to detect possible prognostic determinants. RESULTS: We performed isolated septal myectomy in 59 patients and a combined procedure in 10 patients. Mean outflow tract gradient decreased by 72.2 mmHg (SD 37.3) and there was a mean reduction in thickness of 8.2 mm (SD 5.8) in the interventricular septum. Functional capacity, measured as New York Heart Association class, and angina of effort improved significantly after surgery (P < 0.0001). In-hospital mortality rate was 1.44% for isolated myectomy and 4.35% for combined procedures. Global actuarial survival at 5-year follow-up was 87.4%, but if those patients who were in functional class II or less at the time of surgery were considered, survival rose to 100%. However, 43 patients (62.3%) with functional class III or higher were operated upon. CONCLUSIONS: Clinical, haemodynamic and mortality outcomes after surgery were excellent, especially in those patients with mild or few symptoms. However, in our location, surgery is still undertaken at an advanced stage of the natural history of the disease, which may adversely affect prognosis.