Labib S B, Schick E C, Isner J M
Section of Cardiology, Lahey Clinic Medical Center, Burlington, Massachusetts 01805.
J Am Coll Cardiol. 1992 Jun;19(7):1664-8. doi: 10.1016/0735-1097(92)90634-y.
Obstruction of the right ventricular outflow tract from metastatic disease is rare. Eleven previous case reports and three new cases are presented. Two tumor types (pancreas and breast), not previously associated with right ventricular outflow tract obstruction, are included. Congestive symptoms, systolic murmur and right axis deviation or right bundle branch conduction abnormality were universal features. Echocardiography is valuable in the delineation of metastatic cardiac involvement and the detection of intracardiac gradients. Adverse hemodynamic consequences developed in 3 of 10 patients who underwent right heart catheterization in which two died. This procedure should be performed only when absolutely necessary. Metastatic obstruction of the right ventricular outflow tract should be considered in the absence of widespread malignancy because the heart was the sole site of metastasis in 5 of 10 autopsy patients. Two patients with solitary cardiac metastasis benefited from resection of the obstructing tumor, underscoring the importance of early identification of this subgroup.
转移性疾病导致右心室流出道梗阻较为罕见。本文呈现了既往的11例病例报告及3例新病例。其中包括两种此前未与右心室流出道梗阻相关的肿瘤类型（胰腺和乳腺）。充血症状、收缩期杂音以及电轴右偏或右束支传导异常是普遍特征。超声心动图对于明确转移性心脏受累及检测心内压力阶差很有价值。10例行右心导管检查的患者中有3例出现了不良血流动力学后果，其中2例死亡。仅在绝对必要时才应进行此操作。在无广泛恶性肿瘤的情况下，应考虑右心室流出道转移性梗阻，因为在10例尸检患者中有5例心脏是唯一的转移部位。2例孤立性心脏转移患者因切除梗阻性肿瘤而获益，这凸显了早期识别该亚组的重要性。
