Ali M K, Ewer M S, Cangir A, Fisher D J
Cardiopulmonary Section, University of Texas, M.D. Anderson Hospital and Tumor Institute, Houston 77030.
Am J Pediatr Hematol Oncol. 1987 Fall;9(3):200-3.
A 16-year-old patient underwent partial gastrectomy for leiomyosarcoma of the stomach. Following resection, he received combination chemotherapy that included Adriamycin and dimethyltriazenoimidazole carboxamide (DTIC), with the cumulative Adriamycin dose being 405 mg/m2. The patient was subsequently treated with vincristine, actinomycin D, and cyclophosphamide. Six hours after receiving his fourth dose of cyclophosphamide, the patient developed signs and symptoms of acute anterior wall myocardial infarction. Although he recovered from this initial cardiac event, he subsequently experienced several additional episodes of vascular occlusion involving the cerebral, femoral, coronary, and pulmonary arteries. Cardiac catheterization demonstrated all coronary arteries to be normal. Both ventricles were hypokinetic, and bilateral mural thrombi were demonstrated; these were the presumed source of the embolic phenomena. To our knowledge, this is the first description of repeated coronary artery embolization following cancer chemotherapy in a patient without evidence of preexisting cardiac abnormalities.
一名16岁患者因胃平滑肌肉瘤接受了部分胃切除术。切除术后，他接受了包括阿霉素和二甲基三氮烯咪唑甲酰胺（DTIC）的联合化疗，阿霉素累积剂量为405mg/m²。该患者随后接受了长春新碱、放线菌素D和环磷酰胺治疗。在接受第四剂环磷酰胺6小时后，患者出现急性前壁心肌梗死的体征和症状。尽管他从这一最初的心脏事件中康复，但随后又经历了几次涉及脑、股、冠状动脉和肺动脉的血管闭塞发作。心脏导管检查显示所有冠状动脉均正常。两个心室运动减弱，并显示有双侧壁血栓形成；这些被认为是栓塞现象的来源。据我们所知，这是首次描述在无既往心脏异常证据的患者中癌症化疗后发生反复冠状动脉栓塞。
