Cinconze Sebastian, Coppini Lucia, Lina Daniela, Tadonio Iacopo, Cattabiani Maria Alberta, Solinas Emilia, Vignali Luigi, Menozzi Alberto
U.O.C. Cardiologia, Dipartimento Cardio-Nefro-Polmonare, Azienda Ospedaliero-Universitaria di Parma.
G Ital Cardiol (Rome). 2017 Sep;18(9):668-671. doi: 10.1714/2741.27951.
We report the case of a 34-year-old female treated with radiotherapy and chemotherapy for non-Hodgkin lymphoma at the age of 16. The patient came to our attention because of progressive dyspnea on effort and a positive result on a pharmacologic stress echo test. Coronary angiography revealed focal critical ostial stenosis of the left main coronary artery. Considering the high surgical risk due to possible post-radiation thoracic adherence and the young patient age, she underwent successful stenting of the left main stenosis with drug-eluting stent, followed by an intravascular ultrasound-guided post-dilation and final kissing balloon inflation. The procedure was uncomplicated.Heart diseases are among the frequently seen long-term effects of chemo/radiotherapy used for lymphoma treatment. The pathogenesis of radiation-induced coronary artery disease is complex and not yet fully understood, the mechanism is multifactorial and likely involves direct damage from radiation exposure or mediated by inflammatory cytokine secretion. Surgery management is often challenging due to radiation sequences, and a percutaneous approach is therefore used. The risk of long-term radiotherapy damage depends on radiation dose and the field of exposure. Modern techniques with lower radiation exposure and smaller treatment volumes may reduce these risks in future.
我们报告了一例34岁女性患者的病例，该患者16岁时因非霍奇金淋巴瘤接受了放疗和化疗。患者因运动时进行性呼吸困难以及药物负荷超声心动图检查结果呈阳性而引起我们的关注。冠状动脉造影显示左主干冠状动脉局限性严重开口狭窄。考虑到由于可能存在放疗后胸部粘连以及患者年轻，手术风险较高，她成功接受了药物洗脱支架置入左主干狭窄处的手术，随后进行了血管内超声引导下的后扩张以及最后的双球囊对吻扩张。手术过程顺利。心脏病是淋巴瘤治疗中常用的化疗/放疗常见的长期影响之一。放射性冠状动脉疾病的发病机制复杂，尚未完全明确，其机制是多因素的，可能涉及辐射暴露的直接损伤或由炎性细胞因子分泌介导。由于放疗后遗症，手术治疗往往具有挑战性，因此采用经皮介入方法。长期放疗损伤的风险取决于辐射剂量和照射野。未来，采用辐射暴露较低和治疗体积较小的现代技术可能会降低这些风险。
