Vawdrey Daniel B F, Fitzsimmons Samantha, Veldtman Gruschen R, Carpenter John-Paul
Wessex Cardiothoracic Centre, Southampton, UK.
BMJ Case Rep. 2013 Sep 24;2013:bcr2013201123. doi: 10.1136/bcr-2013-201123.
We present a case of a middle-aged man with a 3-month history of progressive shortness of breath and peripheral oedema. Ten years prior to this, he had undergone a left pneumonectomy for metastatic bronchial carcinoid. Clinical examination revealed significant right heart failure, supported by transthoracic echocardiography. CT pulmonary angiogram revealed the cause to be marked progression of the bronchial carcinoid causing severe external compression of right pulmonary artery (RPA). In view of the distressing symptoms, a palliative endovascular intervention to the RPA was attempted to relieve obstruction, improve blood flow through the right lung and offload the right ventricle. This was performed under general anaesthesia involving interventional cardiology and radiology specialists together with a specialist anaesthetic team with extensive experience of managing carcinoid patients. The result was a marked improvement in symptoms and right heart function and the patient was discharged 2 days later.
我们报告一例中年男性病例，该患者有3个月进行性气短和外周水肿病史。在此之前十年，他因转移性支气管类癌接受了左肺切除术。临床检查发现明显的右心衰竭，经胸超声心动图检查予以证实。CT肺动脉造影显示病因是支气管类癌显著进展，导致右肺动脉（RPA）严重外部受压。鉴于患者症状令人痛苦，尝试对RPA进行姑息性血管内介入治疗，以缓解梗阻，改善右肺血流并减轻右心室负荷。该治疗在全身麻醉下进行，介入心脏病学和放射学专家以及一个在管理类癌患者方面有丰富经验的专业麻醉团队共同参与。结果患者症状和右心功能显著改善，2天后出院。
