KeywordsMyxoma; giant cell tumors; mitral valve stenosis; adolescent.The echocardiogram of a twenty-year-old man, previously healthy, suffering from paroxysmal nocturnal dyspnea and fatigue after moderate exertion that intensified over a period of about ten days, showed the left atrium myxoma working as severe mitral stenosis. A physical examination revealed blood pressure of 110X70 mmHg, regular two-beat heart rhythm, systolic murmur in mitral area and without any changes in the rest of the physical examination. The electrocardiogram revealed a right bundle branch block. The echocardiogram showed a large mass that occupied almost the entire left atrium (4.3 x 8.0 cm in size). This mass was stuck to the posterior superior wall of the left atrium. The diameter of the left atrium was 5.6 cm and the estimated volume was 98 cm³. Part of the mass protruded through the mitral valve to the left ventricle during the atrial systole (the estimated valve area was 1 cm²), causing a restriction of the mitral flow that was compatible with severe stenosis (severe mitral stenosis). Then, surgery was indicated for removal of the tumor. Giant Atrial Myxoma Mimicking Severe Mitral Stenosis in Young PatientIn preoperative examinations, the only change found was microcytic and hypochromic anemia. Then, the exeresis of the tumor was performed with resection of the fossa ovalis and atrioseptoplasty was performed with the use of bovine pericardium. The histopathology of the specimen confirmed the diagnosis of left atrial myxoma. There were no complications in the postoperative period and the patient was discharged five days after surgery.
Resumo O crescimento significativo do número de indivíduos dependentes de hemodiálise para terapia renal substitutiva e o uso irrestrito de cateteres de curta e longa permanência têm desafiado os cirurgiões vasculares em busca de soluções para a exaustão de acessos nos membros superiores e taxas crescentes de estenose venosa central nesses pacientes. Na impossibilidade do acesso em membros superiores, técnicas excepcionais podem ser utilizadas, e os membros inferiores são uma alternativa factível como sítio de acesso vascular para hemodiálise. Este artigo relata um caso de transposição de veia femoral superficial para confecção de uma fístula arteriovenosa em alça em um paciente sem possibilidade de acessos nos membros superiores, além de fazer uma revisão da literatura sobre essa técnica ainda pouco utilizada.
The significant growth in the number of individuals dependent on hemodialysis for renal replacement therapy and unrestricted use of short and long-term catheters have challenged vascular surgeons in search of solutions for patients whose options for access via the upper limbs have been exhausted and for the increasing rates of central venous stenosis in these patients. When access via the upper limbs is impossible, exceptional techniques can be used and the lower limbs offer feasible alternative vascular access sites for hemodialysis. This article reports a case of superficial femoral vein transposition to make a loop arteriovenous fistula in a patient with no possibility of access via the upper limbs and presents a literature review on this technique that remains little used.
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