Cardiology Division, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Shinchon-dong, 120-752 Seoul, South Korea.
J Am Soc Echocardiogr. 2010 Jun;23(6):682.e5-7. doi: 10.1016/j.echo.2009.10.008. Epub 2009 Dec 3.
A 52-year-old woman presented with severe dyspnea of 2 weeks' duration. Echocardiography showed an enlarged left atrium but normal global left ventricular systolic function. However, a huge, irregularly shaped mass at the dilated coronary sinus that extended into the right atrium was noted. Mitral inflow showed restrictive physiology and the E/E' ratio was significantly elevated, suggesting elevated left ventricular filling pressures. Echocardiography-guided biopsy was performed, and a diagnosis of primary cardiac lymphoma (diffuse large B-cell type) was made. After the first cycle of chemotherapy, the patient's symptom was markedly improved. A follow-up echocardiogram showed complete removal of the mass and a change in left ventricular filling pattern from restrictive to relaxation abnormality with decreased E/E'. The present case demonstrates a rare cause of diastolic dysfunction due to coronary sinus obstruction by tumor infiltration. Diastolic dysfunction caused by coronary sinus obstruction was improved after the tumor was resolved by chemotherapy.
一位 52 岁女性因严重呼吸困难就诊，症状持续了 2 周。超声心动图显示左心房扩大，但整体左心室收缩功能正常。然而，在扩张的冠状窦内发现一个巨大的、不规则形状的肿块，延伸至右心房。二尖瓣血流显示限制型生理学，E/E'比值显著升高，提示左心室充盈压升高。进行了超声心动图引导下的活检，诊断为原发性心脏淋巴瘤（弥漫性大 B 细胞型）。在第一个化疗周期后，患者的症状明显改善。后续的超声心动图显示肿块完全消失，左心室充盈模式从限制型变为松弛异常，E/E'降低。本病例显示了一种因肿瘤浸润导致冠状窦阻塞而引起舒张功能障碍的罕见原因。化疗使肿瘤消退后，由冠状窦阻塞引起的舒张功能障碍得到改善。
