Schenker Niklas, Kaiser Lukas, Bohnen Sebastian, Hakmi Samer
Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, 20099 Hamburg, Germany.
Eur Heart J Case Rep. 2023 Feb 27;7(3):ytad107. doi: 10.1093/ehjcr/ytad107. eCollection 2023 Mar.
Malignant cardiac tumours are rare entities that cause severe morbidity and mortality. Possible treatment options vary between surgical removement, (immuno-) chemotherapy, and palliative care, whilst diagnostic workup comprises of imaging and histopathology analysis. Excimer laser sheaths are a new possibility to extract significant tissue samples to offer adequate treatment.
A 67-year-old Caucasian female presented with progressive shortness of breath, new onset of fevers, weight loss, and recurrent night sweats. She showed signs of upper venous stasis.Cardiac imaging revealed an obstructive, hypoperfused right atrial mass superior to the tricuspid valve and a sessile structure at the mitral valve. Guideline-directed therapy for endocarditis was started subsequently.A conventional intracardiac biopsy of the tumour was unsuccessful, but an off-label approach using an excimer laser sheath as bioptome leads to the diagnosis of a diffuse large B-cell lymphoma. Immuno-chemotherapy was commenced, leading to reduction in tumour size and rapid improvement in the quality of life.
Intracardiac biopsies are an important piece of the puzzle in the diagnostic workup of cardiac neoplasms. This case report is the first description of the utilization of a laser lead extraction tool as a bioptome for intracardiac tumours. Two imaging modalities (echocardiogram, fluoroscopy), as well as the precise technique of the excimer laser, ensured safety for the patient. Clinical studies are paramount to further evaluate the laser sheath as a possible new instrument in the toolbox of an interventional cardiologist.
恶性心脏肿瘤是罕见的疾病，可导致严重的发病率和死亡率。可能的治疗选择包括手术切除、（免疫）化疗和姑息治疗，而诊断检查包括影像学和组织病理学分析。准分子激光鞘是提取大量组织样本以提供充分治疗的一种新方法。
一名67岁的白种女性出现进行性气短、新发发热、体重减轻和反复盗汗。她表现出上腔静脉淤血的体征。心脏成像显示三尖瓣上方有一个阻塞性、灌注不足的右心房肿块，二尖瓣处有一个蒂状结构。随后开始了针对心内膜炎的指南指导治疗。对肿瘤进行的传统心内活检未成功，但使用准分子激光鞘作为活检钳的非标签方法导致诊断为弥漫性大B细胞淋巴瘤。开始免疫化疗后，肿瘤大小减小，生活质量迅速改善。
心内活检是心脏肿瘤诊断检查中的重要环节。本病例报告首次描述了将激光引导提取工具用作心内肿瘤活检钳的情况。两种成像方式（超声心动图、荧光透视）以及准分子激光的精确技术确保了患者的安全。临床研究对于进一步评估激光鞘作为介入心脏病学家工具库中一种可能的新器械至关重要。
