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Rechtsatriales Myxom bei SLE und sekundärem Antiphospholipid-Syndrom

Ein ausführlicher Fallbericht

Right atrial myxoma with SLE and antiphospholipid syndrome

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Clinical Research in Cardiology Supplements Aims and scope

Zusammenfassung

In diesem Fallbericht über eine 48-jährige Patientin wird der seltene Befund eines kardialen Myxoms bei systemischem Lupus erythematodes (SLE) und Antiphospholipid-Syndrom (APS) dargestellt. Wir übernahmen die Patientin zur transösophagealen Kontrolle einer seit 5 Jahren bekannten rechtsatrialen Raumforderung. Anhand der echokardiographischen Kriterien bestand der Verdacht auf ein Myxom. Aufgrund des erhöhten Risikos für systemische thromboembolische Ereignisse war die chirurgische Resektion der Raumforderung und der Verschluss eines persistierenden Foramen ovale indiziert. Nach unkompliziertem perioperativen Verlauf machte sich eine erneute Hospitalisierung bei verzögerter Rekonvaleszenz und persistierenden bilateralen Pleuraergüssen erforderlich. Weiterführend ist die kurzfristige echokardiographische Kontrolle und orale Antikoagulation unter dem Verdacht eines Thrombus bei persistierender rechtsatrialer Raumforderung angezeigt.

Kardiale Tumoren sollten mittels transösophagealer Echokardiographie evaluiert werden. Kardiale Myxome erfordern die chirurgische Resektion. Patienten mit systemischen Kollagenosen bedürfen einer individuellen perioperativen Risikostratifizierung und intensiver kardiologischer und rheumatologischer Kontrolle bis zum Erreichen der postoperativen Rekonvaleszenz. Aufgrund eines erhöhten Risikos für Thrombenbildung sollte die effektive orale Antikoagulation bei Patienten mit APS im Einzelfall überdacht werden.

Abstract

Abstract

Presenting a case report of a 48-year-old woman, the rare association of cardiac myxoma with systemic lupus erythematodes (SLE) and antiphospholipid syndrome (APS) is reported. After a 5-year period of echocardiographic control, we were involved in transesophageal echocardiographic assessment of a right atrial cardiac mass. Due to echocardiographic signs a myxoma was suspected. As a consequence of the increased risk of systemic thromboembolic events, surgical resection of the atrial mass and occlusion of a persistent oval foramen was indicated. After uncomplicated perioperative management, a prolonged reconvalescence and persistent bilateral pleural effusion made re-hospitalization necessary. Further echocardiographic control and oral anticoagulation therapy was indicated due to a persistent right atrial mass, suggesting a thrombus.

Conclusion

Cardiac tumors should be assessed by transesophageal echocardiography. Surgical removeal of cardiac myxoma is essential. Patients with systemic collagenous diseases need perioperative risk stratification and intensive cardiologic and rheumatologic monitoring until postoperative reconvalescence. Due to the increased risk of thrombosis, effective anticoagulation therapy in patients with APS should be considered.

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Authors and Affiliations

  1. Praxisklinik Herz und Gefäße, Kardiologie – Angiologie – Radiologie – Nuklearmedizin, Akademische Lehrpraxisklinik der TU Dresden, Forststraße 3, 01099, Dresden, Germany

    B. Krosse &  M. Schönmetzler

  2. Herzzentrum Dresden GmbH, Univeristätszentrum, Klinik für Kardiochirurgie, Fetscherstraße 78, 01307, Dresden, Germany

    U. Kappert

Authors
  1. B. Krosse
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  2. M. Schönmetzler
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  3. U. Kappert
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Correspondence to B. Krosse.

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Krosse, B., Schönmetzler, M. & Kappert, U. Rechtsatriales Myxom bei SLE und sekundärem Antiphospholipid-Syndrom. Clin Res Cardiol Suppl 3, 35–40 (2008). https://doi.org/10.1007/s11789-008-0036-x

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  • DOI: https://doi.org/10.1007/s11789-008-0036-x

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