Institute for Clinical and Experimental Medicine, Charles University in Prague, Prague, Czech Republic.
ASAIO J. 2013 May-Jun;59(3):320-1. doi: 10.1097/MAT.0b013e318289b992.
Hodgkin's lymphoma is a quite frequent diagnosis, particularly in younger patients, which is normally treated effectively with combined chemotherapy and radiotherapy. Cardiomyopathy induced by these treatments is not uncommon and may progress to advanced-stage heart failure. Due to the cardiotoxicity of chemotherapy for Hodgkin's disease, preexisting heart failure precludes usual therapy. We present a novel strategy of hemodynamic stabilization with an implantable left ventricular assist device (LVAD) prior to radical oncotherapy for Hodgkin's lymphoma. A 33-year-old man with a short history of progressive heart failure was hospitalized due to progressive symptoms. An echocardiogram revealed a dilated left ventricle with an ejection fraction of 18%, moderate right ventricular dysfunction, and moderate to severe tricuspid regurgitation. Supradiaphragmatic-stage Hodgkin's lymphoma was also diagnosed. Due to severe cardiac dysfunction, the patient was not a candidate for the usual chemotherapy and radiotherapy prescribed for this diagnosis. After multidisciplinary consultation and consent from the patient, an LVAD was implanted with tricuspid valve repair. Additionally, affected lymph nodes from the ventral upper mediastinum were excised, and pathological analysis confirmed the lymphoma diagnosis. The patient recovered from surgery and the postoperative course was uneventful. With LVAD support and normalized hemodynamics, chemotherapy and radiotherapy for his Hodgkin's lymphoma were completed, and the patient remains in complete remission documented by positron emission tomography/computed tomography and is well one since LVAD implantation.
霍奇金淋巴瘤是一种相当常见的诊断，特别是在年轻患者中，通常采用联合化疗和放疗进行有效治疗。这些治疗引起的心肌病并不少见，并可能进展为晚期心力衰竭。由于霍奇金病的化疗具有心脏毒性，因此预先存在的心力衰竭会妨碍常规治疗。我们提出了一种新的策略，即在霍奇金淋巴瘤根治性放化疗前使用植入式左心室辅助装置（LVAD）进行血流动力学稳定。一名 33 岁的男性，有短时间进行性心力衰竭病史，因进行性症状住院。超声心动图显示左心室扩张，射血分数为 18%，中度右心室功能障碍，中度至重度三尖瓣反流。还诊断出膈上阶段霍奇金淋巴瘤。由于严重的心脏功能障碍，患者不符合该诊断规定的常规化疗和放疗标准。经过多学科咨询并征得患者同意后，植入了 LVAD 并进行了三尖瓣修复。此外，还切除了前上纵隔受累的淋巴结，病理分析证实了淋巴瘤的诊断。患者术后恢复良好，无并发症。在 LVAD 支持和正常血流动力学的情况下，完成了他的霍奇金淋巴瘤的化疗和放疗，并且通过正电子发射断层扫描/计算机断层扫描证实患者完全缓解，自 LVAD 植入以来患者情况良好。
