원발성 심장 종양의 임상적 고찰 = Clinical Experiences for Primary Cardiac Tumors

다국어 초록 (Multilingual Abstract)

Background: Primary cardiac tumors are known to be rare. We studied the surgical results for primary cardiac tumors. Material and Method: Between August 1980 and December 2003, we classified 86 patients who had operation for primary cardiac tumors in our center into 3 groups; myxoma, nonmyxoma benign tumors, and malignant tumors. The mean age was 44.3±20.8 years and 59 patients (66.3%) were female. In postoperative pathologic diagnosis, there were 81 cases (94.2%) of benign tumors in which myxoma was the most common tumor (70 cases, 78.7%); 5 fibroma (5.6%), 3 rhabdomyoma (3.4%), and 5 malignant tumors (5.8%). Result: 86.4% of benign tumor was myxoma and the mean age was 50.4±15.4 (range 7～80) years. Tumor was more common in females (49 cases) and most common preoperative symptom was dyspnea (62.9%). 57 cases were located at left atrial septum and only one case, which was located at right ventricular septum, was resected incompletely. There were no hospital deaths and one patient had mitral valve replacement on the first operative day due to newly developed postoperative mitral regurgitation. The mean follow up period was 109.3±71.8 months and there was no evidence of recurrence in this period. 11 cases (12.8%) were nonmyxoma benign tumors; 5 fibromas, 3 rhabdomyomas, etc. There were two hospital deaths and the causes of death were fungal endocarditis and hypoxia. There were no reoperations in nonmyxoma benign tumors. Malignant tumors were in 5 cases (5.8%); undifferentiated sarcoma in 2, rhabdomyosarcoma in 1, etc. Although there were no hospital mortalities, 3 patients who were followed up died from complications of tumors. Conclusion: Myxomas showed very excellent prognosis after complete resection and nonmyxoma benign tumors showed relatively good results for relief of symptoms. Surgery helped to relieve symptoms for malignant tumors, but the prognosis was poor.

국문 초록 (Abstract)

배경: 원발성 심장 종양은 비교적 드문 질환으로 알려져 있다. 저자들은 수술을 시행받은 원발성 심장 종양의 결과에 대하여 살펴보았다. 대상 및 방법: 1980년 8월부터 2003년 12월까지 연세심장혈관 병원에서 원발성 심장 종양으로 수술을 시행 받은 86명의 환자들을 대상으로 병리적 진단에 따라 점액종, 점액종외의 양성 종양 및 악성 종양으로 나누어 고찰하였다. 환자들의 평균 연령은 44.3±20.8세였으며 남자가 29명(33.7%) 여자가 59명(66.3%)이었다. 수술 후 병리적 진단으로는 양성 종양이 81예(94.2%)였고 이 중 점액종이 70예(78.7%)로 가장 많았으며 섬유종이 5예(5.6%), 횡문근종이 3예(3.4%)였고, 악성 종양은 5예(5.8%)였다. 결과: 점액종은 양성 종양의 86.4%였고 환자들의 평균 나이는 50.4±15.4 (7～80)세였다. 여자가 49명(70%)이었으며 가장 흔한 증상은 호흡 곤란(62.9%)이었다. 종양은 57예(81.4%)에서 좌심방 중격에 위치하였고, 우심실 중격에 위치한 1예를 제외하고는 모두 완전 절제가 가능하였다. 수술 사망은 없었으며 1예에서 수술 후 승모판막 부전이 발생하여 승모판막 대치술을 시행 받았다. 평균 추적 관찰 기간은 109.3±71.8개월이었고 이 기간 중 종양의 재발 소견을 보인 환자는 없었다. 점액종외의 양성 종양은 11예(12.8%)로 섬유종이 5예, 횡문근종이 3예였다. 2예에서 진균성 심내막염 및 저산소증으로 인한 수술 사망이 있었으며 재수술은 없었다. 악성 종양은 5예(5.8%)로 미분화성 육종이 2예, 횡문근육종 1예 등이었고, 수술 사망은 없었으나 추적이 가능했던 3예에서 합병증에 의한 사망이 있었다. 결론: 점액종은 완전 절제 후 예후가 매우 좋았으며, 점액종외의 양성 종양은 증상 완화에 도움이 되었다. 악성종양은 종양과 관련된 증상을 완화시키기 위하여 수술이 필요하였으나 예후는 불량하였다.

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