Récidive d`un myxome Cardiaque non Familial

108
,</4:7:240%?94=40990':7?80H0< %<480=><0
Correspondance
Fennira Sana
Service de Cardiologie, Hôpital Habib Thameur.
8, rue Ali Ben Ayed- Montfleury 1008-Tunis
Mail : [email protected]
Récidive d’un myxome cardiaque non familial :
A propos d’un cas
Recurrence of a non-family cardiac myxoma:
A case report
Résu mé
Le myxome est la tumeur cardiaque primitive la plus fréquente. Le plus souvent la résection chirurgicale
est un traitement définitif. Cependant, quelques cas de récidive ont été rapportés dans la littérature. Dans
ce cadre nous rapportons l’observation d’un myxome cardiaque non familial qui a récidivé 6 ans après
la 1ère résection, découvert à l’occasion d’une échocardiographie de contrôle et qui a nécessité la réinter-
vention chirurgicale.
Summ ary
Cardiac myxomas are the most common primary cardiac tumors. Surgical resection usually provides
definitive treatment. However, postoperative tumor recurrence has been described. We report the case of
a cardiac myxoma recurrence detected in cardiac echocardiography 6 years later and have necessitated
the surgical reoperation.
0994<,$,9,9>4>$,:?==093,7/4,-4-77:?C0*,==49073,58:<,==09<,-0>,4=09:?==,0>34,+,4<43=09,8:?9
$:1409<,408$:9/:=
Service de Cardiologie, Hôpital Habib Thameur, Tunis, Tunisie
Mots-clés
Myxome cardiaque ;
Récidive ; échocardiogra-
phie
Keywords
Cardiac myxoma;
Recurrence;
Echocardiography
FAIT clINIqUE
, # )&)!#
. / ( # - #  ( ( 

IntroductIon
?;DGK;H7H;:;I97H:?EF7J>?;I56B;CONEC;
;IJB7JKC;KH97H:?7GK;B7FBKI<HUGK;DJ;9>;PBk7:KBJ;
7L;9 KD; ?D9?:;D9; :k;DL?HED  C?BB?ED :k?D:?L?:K
F7H 7D 56 &7 HU9?:?L; :; CONEC; 97H:?7GK; 7FHVI B7
HUI;9J?ED 9>?HKH=?97B; ;IJ H7H; 7DI 9; 97:H; DEKI
H7FFEHJEDI B; 97I :kKD; HU9?:?L; :; CONEC; ?DJH7
7KH?9KB7?H;
caS cLInIquE
'H ' S=U :; 7DI I7DI 7DJU9U:;DJI F7J>EBE=?GK;I
DEJ78B;I 9EDIKBJ7?J FEKH :OIFDU; :k;<<EHJ ULEBK7DJ
:;FK?ICE?I:k7==H7L7J?EDHU9;DJ;&k;N7C;DF>OI?GK;
JHEKL7?J KD HEKB;C;DJ :?7IJEB?GK; 7K <EO;H C?JH7B 7L;9
78I;D9; :; I?=D;I :k?DIK<<?I7D9; 97H:?7GK;
&kUB;9JHE97H:?E=H7CC; ?DI9H?L7?J KD HOJ>C; HU=KB?;H
I?DKI7BR9O9B;IC?DI7DIJHEK8B;:;B79ED:K9J?EDD?
:;B7H;FEB7H?I7J?ED&7H7:?E=H7F>?;:KJ>EH7NUJ7?JI7DI
7DEC7B?;I &kU9>E97H:?E=H7F>?; JH7DIJ>EH79?GK; ..
E8@;9J?L7?JKD;C7II;U9>E=VD;EL7B7?H;<7?I7DJ9C:;
=H7D:7N;I?V=;7DJ7KD?L;7K:;BkEH;?BB;JJ;=7K9>;7L;9
KD; 87I; :k?CFB7DJ7J?ED B7H=; 7K D?L;7K :K I;FJKC
?DJ;H7KH?9KB7?H; ?=KH;
;JJ; C7II; Ik;D9B7L7?J F7H CEC;DJ 7K D?L;7K :;
BkEH?<?9; C?JH7B &; :?7=DEIJ?9 :; CONEC; E8IJHK7DJ
BkEH?<?9;C?JH7B7UJUFEIU;JB;C7B7:;7UJU7:H;IIU;D
KH=;D9; FEKH 9>?HKH=?; &k;N7C;D C79HEI9EF?GK;
JHEKL7?J KD; JKC;KH FEBOBE8U; :k7IF;9J >UCEHH7=?GK;
:; 9EDI?IJ7D9; =UB7J?D;KI; <H?78B; ;J DED 7:>UH;DJ;
 ?=KH;&;F7J?;DJ78UDU<?9?U:kKD;;NUHVI;:;9;JJ;
C7II;7L;9<;HC;JKH;:;:U<;9JI;FJ7BF7HF7J9>
&kUJK:; >?IJEBE=?GK; CEDJH7?J KD; <EHC7J?ED JKCEH7B;
9EDIJ?JKU; F7H :;I 9;BBKB;I 9ED@ED9J?L;I <KI?<EHC;I ;J
UJE?BU;I DED 9E>UI?L;I DED 7JOF?GK;I :?IF;HIU;I :7DI
KD IJHEC7 CONEZ:; ;J <?8H?BB7?H; :UB?C?JU F7H KD; <?D;
97FIKB;<?8H;KI;;J7IF;9J>?IJEBE=?GK;;IJ9ECF7J?8B;
7L;9 KD CONEC; 97H:?7GK; ;FK?I B; F7J?;DJ <KJ
7IOCFJEC7J?GK;;JIK?L?HU=KB?VH;C;DJRB79EDIKBJ7J?ED
7DI7FHVIBk..:;9EDJH]B;FK?IBkU9>E97H:?E=H7F>?;
JH7DIE;IEF>7=?;DD; E8@;9J?L7?;DJ KD; C7II; U9>E=VD;
7HHED:?;NCCI;II?B;?DIUHU;IKHB;L;HI7DJ=7K9>;
:K I;FJKC ?DJ;H7KH?9KB7?H; ;J F7HJ?;BB;C;DJ 7K F7J9>
 ?=KH;
109
Cardiologie Tunisienne
2ème Trimestre 2013
Fennira S. & al.
Figure 1: coupe 4 cavités en sous costal. Masse échogène
attachée au septum interatrial.
Figure 2 : Aspect macroscopique du myxome auriculaire
gauche
Figure 3 : Récidive du myxome atrial gauche objectivée à
l’ETO

110
Cardiologie Tunisienne
2ème Trimestre 2013
#D' I& *)  #"&   
BB;DkUJ7?J F7I E8IJHK9J?L; BB; ULEGK7?J B; :?7=DEIJ?9
:;HU9?:?L;:KCONEC; &; F7J?;DJ 7?J 8UDU<?9?U :kKD;
:;KN?VC; HUI;9J?ED 9>?HKH=?97B; :; 9;JJ; C7II; ;J :;
IED FU:?9KB; &k;N7C;D 7D7JECEF7J>EBE=?GK; :; B7
F?V9; EFUH7JE?H; 9ED<?HC7?J B; :?7=DEIJ?9 :; CONEC;
&k;DGKWJ;<7C?B?7B;D;JHEKL7?JF7I:;97II?C?B7?H;I:7DI
B7 <7C?BB; FHVI 7DI :kULEBKJ?ED B; F7J?;DJ <KJ
HU=KB?VH;C;DJ IK?L? #B Dk7 F7I ;K :k7KJH; HU9?:?L; :K
CONEC;
dIScuSSIon
&; H?IGK; :; HU9?:?L; :; CONEC; 97H:?7GK; ;IJ :;
BkEH:H;:;R:7DIB;I<EHC;IIFEH7:?GK;I#BF7II;R
:7DIB;I<EHC;I<7C?B?7B;I;J=H?CF;R:7DIB;
IOD:HEC; :; 7HD;O CONEC; 9KJ7DU CONEC;
97H:?7GK; ;J IOD:HEC; :; 9KI>?D= &7 HU9?:?L; F;KJ
IKHL;D?H:7DI:;ICONEC;ICKBJ?FB;I56&7HU9?:?L;
;IJ FBKI <HUGK;DJ; :7DI B;I <EHC;I <7C?B?7B;I R
JH7DIC?II?ED7KJEIEC7B;:EC?D7DJ;GK?9EDIJ?JK;DJ
:;ICONEC;I97H:?7GK;I56-;KB;C;DJ97I:;:;KN
HU9?:?L;I:;CONEC;I97H:?7GK;IEDJUJUH7FFEHJUI:7DI
B7B?JJUH7JKH;56
&7HU9KHH;D9;F;KJWJH;I;9ED:7?H;IE?JRKD;HUI;9J?ED
?D9ECFBVJ;:;B7C7II;IE?JRBk;C8EB?;:;I<H7=C;DJI
7K9EKHI:;Bk;NJH79J?ED:;IJKC;KHIJHVI<H?78B;IIE?JR
B7 FHUI;D9; :; JKC;KHI CKBJ?<E97B;I DED ?:;DJ?<?78B;I
C79HEI9EF?GK;C;DJ EK FBKI H7H;C;DJ R B7
JH7DI<EHC7J?EDC7B?=D;:KCONEC;56
?;D GKk?BI IE?;DJ 8UD?DI 9;HJ7?DI CONEC;I 97H:?7GK;I
F;KL;DJ 7LE?H KD FEJ;DJ?;B ?DJH?DIVGK; :; C7B?=D?JU
9ECC; T7 UJ7?J :UCEDJHU F7H B7 FHUI;D9; :; BUI?EDI
>?IJEBE=?GK;I FBKI 7=H;II?L;I :7DI B;I F?V9;I
7D7JECEF7J>EBE=?GK;I :;I CONEC;I HU9?:?L7DJI56 &;
CONEC; F;KJ CWC; I; JH7DI<EHC;H ;D I7H9EC; D
;<<;JB;CONEC;;IJKD;JKC;KH:kEH?=?D;;D:E97H:?GK;
9EDIJ?JKU; :; 9;BBKB;I CUI;D9>OC7J;KI;I 7O7DJ
CKBJ?FB;IFEJ;DJ?;BIBB;IIEDJ97F78B;I:;:;L;D?H:;I
9;BBKB;ID;KH7B;IEK;D:EJ>UB?7B;I56
&7 CKJ?<E97B?JU :;I JKC;KHI C?9HEI9EF?GK;I ;IJ KD;
>OFEJ>VI;FEII?8B;D;<<;J:7DI9;HJ7?DI97IFK8B?UI
B;CONEC;HU9?:?L7DJ;IJ:;I?V=;:?<<UH;DJ:;B7JKC;KH
FH?C?J?L;56
&7 IOCFJEC7JEBE=?; ;D 97I :; HU9?:?L; ;IJ I?C?B7?H; R
9;BB; :K CONEC; FH?C?J?< BB; :UF;D: :; B7 J7?BB; :K
I?V=; ;J :; B7 CE8?B?JU :; B7 JKC;KH /D EK FBKI?;KHI
IOCFJ]C;I :; B7 JH?7:; JOF?GK; F;KJ WJH; FHUI;DJ
799?:;DJ ;C8EB?GK; I?=D;I =UDUH7KN 9ED=;IJ?ED
FKBCED7?H; ;I <H7=C;DJI JKCEH7KN EK :;I ;C8EBI
<EHCUIRB7IKH<79;:;B7JKC;KHF;KL;DJ;NFB?GK;HB;I
799?:;DJI ;C8EB?GK;I GK? IKHL?;DD;DJ 9>;P  :;I
F7J?;DJI 56 &7 B?8UH7J?ED :k?DJ;HB;KA?D;  F7H B7
JKC;KH ;IJ R BkEH?=?D; :;I I?=D;I =UDUH7KN 7IJ>UD?;
<?VLH; 7HJ>H7B=?; 7C7?=H?II;C;DJ &;I I?=D;I
:k?DIK<<?I7D9; 97H:?7GK; =7K9>; IEDJ B?UI R KD;
UL;DJK;BB; E8IJHK9J?ED :; B7 L7BL; C?JH7B; F7H B;
CONEC; ;F;D:7DJ B; CONEC; ;IJ IEKL;DJ
7IOCFJEC7J?GK; :kE^ Bk?DJUHWJ :K 9EDJH]B;
U9>E97H:?E=H7F>?GK; HU=KB?;H &7 L?J;II; :; 9HE?II7D9;
:K CONEC; 97H:?7GK; F;KJ WJH; 97B9KBU; ;D I; 87I7DJ
IKH B;I C;IKH;I U9>E97H:?E=H7F>?GK;I ?JUH7J?L;I EK IKH
Bk?DJ;HL7BB;GK?IUF7H;B;I?DJ;HL;DJ?EDI;JJ;L?J;II;
;IJ:;BkEH:H;:;CCCE?IEKCC56
&;JH7?J;C;DJ :;I CONEC;I O 9ECFH?I B;I HU9?:?L;I;IJ
;II;DJ?;BB;C;DJ 9>?HKH=?97B &7 9>?C?EJ>UH7F?; ;J B7
H7:?EJ>UH7F?; EDJ UJU :UB7?IIU;I /D 97I :;
JH7DIFB7DJ7J?ED97H:?7GK;FEKHCONEC;7JH?7BHU9?:?L7DJ
7UJUH7FFEHJU:7DIB7B?JJUH7JKH;56&k7DJ?9E7=KB7J?ED
;IJ H;9ECC7D:U; :7DI B;I 97I ?DEFUH78B;I 7<?D :;
FHUL;D?HB;H?IGK;J>HEC8E;C8EB?GK;
&7FHUI;D9;:;:?<<UH;D9;I=UDUJ?GK;I;DJH;B;I<EHC;I
<7C?B?7B;I;JDED<7C?B?7B;I567UJU:UCEDJHU;7DI
B; <KJKH KD; UJK:; =UDUJ?GK; 9>;P B;I F7J?;DJI EFUHUI
FEKHCONEC;97H:?7GK;F;HC;JJH7?J:;:UF?IJ;H9;KNR
H?IGK; :; HU9?:?L; *EKH B; CEC;DJ KD 9EDJH]B;
U9>E97H:?E=H7F>?GK; HU=KB?;H 9>;P 9;I F7J?;DJI ;IJ
H;9ECC7D:U7<?D:;<7?H;B;:?7=DEIJ?9:kKD;UL;DJK;BB;
HU9?:?L;RJ;CFI
 '9 7HJ>O *' *?;>B;H $' -9>7<< "0 .>; I?=D?<?97D9; E< CKBJ?FB;
H;9KHH;DJ 7D: 9ECFB;N; 97H:?79 CONEC7 $ .>EH79 97H:?EL7I9 IKH=
 7HD;O $ "HKIA7 &- ;7K9>7CF ! !EH:ED " EC?D7DJ ?D>;H?
J7D9;E<J>;9ECFB;NE<CONEC7IIFEJJOF?=C;DJ7J?ED7D:;D:E9H?D;
EL;H79J?L?JO'7OE9B?D?9FHE9
 '7H:EP7;HDIJ;?D ;HH;?H7'KBJ?FB;H;99KH;D9;IE<DED<7C?
B?7B97H:?79CONEC7I.;N";7HJ#DIJ$
 $7D7H,$KJ;B;O,- ;DJED*-7HA7H*->EKB:M;F;H<EHC7FH;EF;
H7J?L; 9EHED7HE=HF>O 7D=?E=H7F>O ?D 7BB 97I;I E< 7JH?7B CONEC7
7J;J>;H97H:?EL7I9KB7H?DJ;HL
 ';D:EI7;HDIJ;?D ;HH;?H7'KBJ?FB;H;9KHH;D9;IE<DED<7C?
B?7B97H:?79CONEC7I.;N>;7HJ?DIJ$
 B;L;B7D:1;IJ78O-%7HF,.H;7JC;DJE<?DJH797H:?79JKCEH
$'
 KJ7DO$(7?H0(7I;;CK::?D(7?H!'7JJED7H:?79JKCEHI
:?7=DEI?I7D:C7D7=;C;DJ&7D9;JED9EB
 *7HM?I,$7L?;H!$7L?;H-7L?:"7H:?79CONEC7F;H?EF;H7
J?L;:?7=DEI?IKI?D=7CKBJ?CE:7B?C7=?D=7FFHE79>7D:IKH=?97BEKJ
9EC;?D7B7H=;9ECJ;CFEH7HOI;H?;I#DJ;H79J97H:?EL7I9J>EH79IKH=
 HE97  ';I7 !' EC?D=K;P  )B?L;H !' ,7C?H;P / CKBJ?FB;
H;9KHH;D9; E< 7 IFEH7:?9 97H:?79 CONEC7 KH $ 97H:?EJ>EH79 IKH=
 CEOII7A?I # D7IJ7IJ7I?7:?I ! '7H=EI * 0EJJ;7I 0 -;9ED: H;99K
H;D9;E<97H:?79CONEC7?D7OEKD=F7J?;DJ97I;H;FEHJ#DJ;H$
7H:?EB
 &7: 0- $7?D $ =7HM7B7 - -?D>7 0% ,?=>J 7JH?7B JH7DII;FJ7B
7FFHE79><EHB;<J7JH?7BCONEC7";7HJBKD=?H9
 #F;A!H;DJK=0*EB7J*;A;H)-KH=?97BC7D7=;C;DJE<97H:?79
CONEC7$97H:IKH=
 -M7HJP' &KJP$>7D:7D0-&7D:7D-JH?7BCONEC7F7J>EBE
=?9 JOF;I JKCEH BE97J?ED 7D: FH;I;DJ?D= IOCFJECI $ 97H: IKH=
 7A7;;D !,;7:ED'$EI;BB?$-'?BB;HIKH=?97BEKJ9EC;?D
F7J?;DJIM?J>FH?C7HO97H:?79JKCEHIC$IKH=
 B8;AA7B?3EKB7>O717>?: 'ONEC;I7JH?7KNRFHEFEI:;97I
EFUHUI,;L'7H97H:?E
rEFErEncES