Herz-und Thoraxchirurgie der Friedrich-Schiller. Schiller-Universität Perikarderkrankungen. T. Bossert

Transkript

1 Perikarderkrankungen T. Bossert

2 Akute Perikarderkrankungen Leitsymptom: Ätiologie: Klinik: Akut-Therapie: Dx.: Klinik (!), Perikardtamponade Infekt, Herzruptur b. AMI, Thoraxtrauma Einflußstauung stauung, Tachykardie, RR-Abfall Entlastung Klinik (!), RöTh,, Herzecho

3 Chron. Perikarderkrankungen Ätiologie:: Klinik: Bakt., viral, uräm., rheum., postop Halsvenenstauung, Aszites, Herzinsuffizienz, EKG Dx.: RöTh,, Herzecho, CT, MRT, L/R HKU

4 Perikard Perikardpunktion Perikarddrainage Perikardektomie Perikardzystektomie

5 Perikarderkrankungen 1. Punktion 2. Inferiore P.tomie 3. Perikardfenster -min. min.-inv. inv. - med. Sternot.

6 Pericarditis constrictiva Narbiger Folgezustand der ak.. P. (Tbc!) Kalkschwielen, chron. Herzinsuffizienz Cave: Mißverh verhältnis RV- Insuff/Gr /Größe!! Klinik: chron. Tamponade, Rö,, Echo RHK: dip plateau Druckangleich RV/RA

7 Pericarditis constrictiva

8 Pericarditis constrictiva - Patient Data Oct. 94 to mar 01 n=21 etiology unknown 12 myocarditis 3 tuberculosis 2 radiatio 2 uremia (NTX) 1 metastases 1

9 Pericarditis constrictiva - Patient Data concomitant cardiac disease 7 KHK 3 3 Endocarditis 1 ASD sinus venosus type 1 KHK 1 1 Aortic stenosis 1 OP-data With ECC 7 Without ECC 14 mortality n=4/21 19 %

10 Bossert T, A Rahmel,, JF Gummert,, R Battellini,, FW Mohr: Pericarditis constrictiva tuberculosa als Ursache einer schweren Rechtsherzinsuffizienz dringliche chirurgische Behandlung. Right heart failure following pericarditis constrictiva tuberculosa urgent surgical treatment. Zentralbl Chir 128;2003;

11 Bossert T, A Rahmel,, JF Gummert,, R Battellini,, FW Mohr: Pericarditis constrictiva tuberculosa als Ursache einer schweren Rechtsherzinsuffizienz dringliche chirurgische Behandlung. Right heart failure following pericarditis constrictiva tuberculosa urgent surgical treatment. Zentralbl Chir 128;2003;

12 Perikardektomie ohne/mit HLM

13 Perikardtumoren Perikardzysten: angeboren / erworben Teratome, Angiome, Lipome,, Fibrome Sarkome, Karzinome, Endotheliome

14 Pericardzysten Selten, embryonaler Ursprung Rechter costophrenischer Winkel Unilokulär,, meist klare Flüssigkeit Meist asymptomatisch, gelegentl.. Torsion Bei Beschwerden Indikation zur Resektion

15 Pericardzysten DD

16 Tumoren des Mediastinums (Hurst et al.)

17 Pericardzysten: Case Report: 52y,w. Adipositas, Dyspnoe

18 Pericardzysten: Case Report: 52y,w. Adipositas, Dyspnoe

19 Pericardzysten: Case Report: 52y,w. Adipositas, Dyspnoe Histo: : Perikardzyste, keine Malignität

20 42-j. Frau mit Herzmetastasen eines Adeno-Ca Ca.. mit unklarem Primärtumor. rtumor. Autopsie: Mikro-Ca. des Pankreas

21 Solitary fibrous tumor of the pleura T Bossert, JF Gummert,, J. Schneider, FW Mohr: Chance finding of a solitary fibrous tumor of the pleura. The Internet Journal of Thoracic and Cardiovascular Surgery 2000; Vol.3,N 2t A 68-year year-old women was referred to our hospital for mitral valve replacement. Chest X-ray was performed routinely before cardiac surgery. We discovered a tumor lateral to the right atrium by chance

22 Solitary fibrous tumor of the pleura CT scan revealed a tumor 4 cm in diameter between the right atrium and the ventral surface of the right lung

23 Solitary fibrous tumor of the pleura The right pleural cavitiy was opened.. A 4 x 6 cm tumorous mass was found. The tumor was attached to the interlobar region of the visceral pleura of the right middle lobe by a highly vascularized peduncle. We excised the tumor with a small part of lung and replaced the mitral valve.

24 Solitary fibrous tumor of the pleura Histology demonstrated a solitary fibrous tumor of the pleura (SFTP). Postoperative course was uneventful. Although the majority of SFTP are benign, the treatment of choice is their complete surgical removal due to malignancy in %. Follow-up examinations will be performed to prevent late recurrence of the SFTP.

25 The rare things in medicine are not rare, only observers are rare. (HR Clouston,, 1939)