Butz T, Schmidt H K, Fassbender D, Esdorn H, Wiemer M, Horstkotte D, Faber L
Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstr 11, D-32545 Bad Oeynhausen, Germany.
Eur J Echocardiogr. 2008 Sep;9(5):725-7. doi: 10.1093/ejechocard/jen153. Epub 2008 Apr 21.
We present the case of a 41-year-old woman who was admitted to our centre with progressive symptoms of congestive heart failure (NYHA class III) 5 years after a radical nephrectomy for renal cell carcinoma. Magnetic resonance imaging demonstrated a 5 x 3 cm homogeneous intracardial mass causing right ventricular outflow tract obstruction, not accessible to surgical resection. Serial echo-guided, percutaneous coil embolization of the cardial metastasis was performed with Contour SE Microparticles (150-250 or 300-500 microm) after identification of the target region of the metastasis by contrast injection (Levovist) through the balloon catheter into the coronary artery under transoesophageal echocardiographic control prior to induction of the necrosis, corresponding to the technique which has been described for septal ablation in hypertrophic obstructive cardiomyopathy. Follow-up after serial embolization showed a good haemodynamic and a marked clinical response (dyspnoea NYHA I-II) which lasted during the 19 month of survival after the index procedure.
我们报告了一例41岁女性患者的病例，该患者在接受肾细胞癌根治性肾切除术后5年，因进行性充血性心力衰竭症状（纽约心脏协会III级）入住我们中心。磁共振成像显示一个5×3厘米的均匀心内肿块，导致右心室流出道梗阻，无法进行手术切除。在经食管超声心动图引导下，通过球囊导管将造影剂（Levovist）注入冠状动脉以识别转移灶的目标区域后，使用Contour SE微球（150 - 250或300 - 500微米）对心脏转移灶进行了系列超声引导下的经皮线圈栓塞，这与肥厚性梗阻性心肌病室间隔消融所描述的技术类似，目的是在诱导坏死之前进行操作。系列栓塞后的随访显示血流动力学良好，临床反应显著（纽约心脏协会I - II级呼吸困难），该反应在首次手术操作后的19个月生存期内持续存在。
