DIAGNOSTIC AND SURGICAL TACTICS IN PSEUDOTUMOROUS VOLUMINOUS HEART FORMATIONS

Abstract

To study clinical and diagnostic, surgical and morphological properties of pseudotumorous heart formations, possibilities for early diagnostics and to invent optimal treatment strategy.Material and methods. Petrovsky Centre for Surgery has the heart tumours treatment experience of 326 patients during the time from December 1962 till December 2010. Morphologically confirmed were tumours of 259 (79,4%) patients. At the current moment the study includes 67 patients with pseudotumorous formations of the heart, continuously supervised at the Centre from February 1960 till December 2010. Of those 36 were males and 31 females at the age of 2,2-74 (median 34,1±2,1),Results. Total survival not including in-hospital mortality, evaluated by Kaplan-Meier method, gained 100% and 94,3% at the 1st and 24th year of observation, respectively. Analysis of the "life quality" of these patients at the remote periods after operation shows its significant improvement. Treatment results claimed as "good" were set for 62,8%; "satisfactory" for 31,4% and "nonsatisfactory" for 5,8% of cases. Treatment strategy for the patients with morphologically not confirmed voluminous formations (29,9%) was predestinated by smaller sizes (4-10 mm diameter), nonmobility thatcould be regarded as the risk for embolism, smooth echogenity with sharp border, absence of hemodynamical malfunction and clinical signs. Conclusion. The analysis has shown that on-time diagnostics of voluminous formations of the heart with pseudotumorous and morphologically non-recognizable properties is very complicated. Clinical awareness while interpreting the short clinical anamnesis and specificities of clinical picture made it possible to realise the individualized choice for the algorhythm of further diagnostics taking into account an oncological determinancy. The success of the operations was predicted by the conditions of normo- or hypotermic perfusion and cold-pharmacological cardioplegy, ensuring optimal exposition and adequate protection for the myocardium, following the rules for prophylaxy of "tumours" fragmentation and embolism, and correction of comorbid valve pathology, inherited valve defects and ischemic heart disease.

Keywords

• pseudotumorous heart formations
• echocardiography
• surgical tactics