DIADIUN D. Diagnosis and surgical treatment of primary non-myxoma heart tumors

The dissertation is devoted to the study of the problems of diagnosis and surgical treatment of primary non-myxoma heart tumors (PNMHT). They represent a rare clinical pathology with an extremely diverse picture of the disease and the complexity of prenatal diagnosis, which determines the need for further research on the standardization of diagnostic approaches and the generalization of criteria for the detection of PNMHT. Surgical treatment of PNMHT is the only method that can save the patient's life. The most important problem of oncosurgery is ensuring the radicality of the intervention. The issue of avoiding the recurrence of neoplasms remains relevant to this day, as evidenced by literary reports, which have significantly increased in recent years. Further improvement of the effectiveness of surgical intervention in PNPS is inextricably linked to the development of measures for the prevention and treatment of operative and postoperative complications. There is still no single view on this problem either. Solving these problems is based on an in-depth study of the immediate and distant results of surgical treatment, which will allow a comparative assessment of the effectiveness of various surgical techniques. The work is based on the analysis of the results of the examination and surgical treatment of 103 consecutive patients with PNMHT observed at the Amosov National Institute of Cardiovascular Surgery for the period from January 1969 to September 1, 2019. In the work, which is based on a sufficiently large clinical material, which includes 35 patients with primary non-myxoma benign heart tumors (PNMBHT) and 68 with primary non-myxoma malignant heart tumors (PNMMHT), a system of diagnosis, differential diagnosis and surgery of PNMHT was developed, which provides a fundamental improvement results of treatment of this pathology. The peculiarities of clinical manifestations have been comprehensively studied, and quantitative differential diagnostic signs of PNMHT have been developed, which allow to suspect the presence of a neoplasm and to refer the patient to additional instrumental studies in a timely manner. Among the studied PNMBHT, patients with papillary fibroelastoma - a neoplasm that usually affects the valvular and chordal apparatus of the heart - were observed most often (9 (25.7%) of 35 cases). In 8 (22.9%) cases, there were hemangiomas and rhabdomyomas of different localization, fibroma was detected in 4 (11.3%) patients, lipoma and leiomyofibroma were found in 3 (8.6%) cases each. It has been proven that the wide variety and variability of PNMBHT localization, their sizes, relation to the valvular apparatus, and the ability to fragment can mimic the clinical picture of various cardiac diseases. It was established that all methods of clinical examination of patients with PNMBHT do not give confidence in the correct diagnosis due to a wide range of clinical manifestations that are not specific for this disease. On the other hand, certain signs, such as noise phenomena, may be absent even with a large volume of the heart and localization of the tumor on the valvular apparatus. Therefore, it is necessary to remember the informativeness of the instrumental methods of research that allow you to visualize the formation or deny its presence, which was confirmed in the clinical cases cited by us. Two-dimensional echocardiography, including transesophageal echocardiography, plays a leading role in diagnosis and differential diagnosis. Having a high resolution, this method quite accurately determines the localization, size, invasive nature of growth in such tumors as rhabdomyomas and fibroids of the heart, papillary fibroelastomas, hemangiomas, as well as the functional state of the valvular apparatus and contractility of the myocardium. Differential diagnosis of PNMBHT can be based mainly on the nature of tumor growth, its mobility, connection with the valve apparatus and is most realistically possible for neoplasms with characteristic invasive growth (rhabdomyoma, fibroma). CT and MRI studies provide additional information that allows more thorough preparation for surgical treatment. However, it should be noted that, according to our experience, the need to use such methods is minimal (8.8%). The final diagnosis of the type of neoplasm is made only during surgical intervention and after histopathological examination. Recommendations for surgical and therapeutic treatment of the tumor depend on the localization of the process, the extent of damage to cardiac structures, and the specifics of its impact on intracardiac hemodynamics. The decisive factor in the effectiveness of surgical treatment of PNMBHT is the timely diagnosis of the disease, which allows radical intervention, while ensuring the maximum hemodynamic effect.