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类癌性右心疾病

Carcinoid Right Heart Disease.

作者信息

Sanchez-Nadales Alejandro, Celis-Barreto Valentina, Anampa-Guzman Andrea, Salazar-Leon Mariani, Contreras-Chavez Pamela

机构信息

Department of Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.

Department of Medicine, Mount Sinai Medical Center, Miami, FL, USA.

出版信息

J Med Cases. 2020 Mar;11(3):73-76. doi: 10.14740/jmc3452. Epub 2020 Mar 26.

Abstract

Carcinoid heart disease is an unusual cause of right heart failure. We present the case of a 53-year-old man with a history of metastatic carcinoid tumors originating from the appendix, status post-chemotherapy, and liver embolizations. The patient presented with a right-sided valvular disease with severe pulmonic valve regurgitation, right ventricle dilation and pulmonary hypertension. He had carcinoid syndrome well controlled with long-acting lanreotide. He underwent tricuspid valve and pulmonary valve replacement with a stented bioprosthetic valve, maze and cardio-septal right ventricular outflow tract patch with an improvement of ventricular dysfunction. These findings supported the diagnosis of carcinoid heart disease presenting with pure right heart failure. The patient was symptom-free due to lanreotide, but ultimately, valve surgery is the preferred definite treatment in suitable patients. Carcinoid heart disease requires a high index of suspicion, and valve surgery is the only definitive treatment.

摘要

类癌性心脏病是导致右心衰竭的一种罕见病因。我们报告一例53岁男性病例,该患者有阑尾来源的转移性类癌肿瘤病史,曾接受化疗及肝脏栓塞治疗。患者表现为右侧瓣膜病,伴有严重的肺动脉瓣反流、右心室扩张和肺动脉高压。他的类癌综合征通过长效兰瑞肽得到了良好控制。他接受了三尖瓣和肺动脉瓣置换术,使用了带支架的生物瓣膜、迷宫手术以及心脏间隔右心室流出道补片,术后心室功能障碍有所改善。这些发现支持了以单纯右心衰竭为表现的类癌性心脏病的诊断。患者因使用兰瑞肽而无症状,但最终,瓣膜手术是适合患者的首选确定性治疗方法。类癌性心脏病需要高度怀疑,瓣膜手术是唯一的确定性治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5eb5/8383519/b2e16abf0b63/jmc-11-073-g001.jpg

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