Xu Shan-Shan, Hao Li-Hai, Guan Yan-Meng
Hemodialysis Center, Weifang People's Hospital, Weifang 261041, Shandong Province, China.
World J Clin Cases. 2024 Mar 6;12(7):1313-1319. doi: 10.12998/wjcc.v12.i7.1313.
Refractory secondary hyperparathyroidism (SHPT) is a common complication observed in patients with end-stage renal disease and can result in ectopic calcification. Metastatic calcification involving the heart valves and the conduction system can easily lead to arrhythmias, including atrioventricular block. This case report describes a maintenance hemodialysis patient with refractory SHPT resulting in a complete atrioventricular block (CAVB), which was eventually reversed to a first-degree atrioventricular block.
We present the case of a 31-year-old Asian female who was receiving maintenance hemodialysis because of lupus nephropathy. She developed SHPT, and an electrocardiogram revealed a first-degree atrioventricular block. Then, she underwent parathyroidectomy (PTX) with autotransplantation. Unfortunately, a few years later, she developed SHPT again, and an electrocardiogram revealed a CAVB. A few years after the second PTX surgery, the calcification of the left atrium and left ventricle improved, and her CAVB was reversed.
This case revealed that metastatic cardiac calcification can result in complete atrioventricular blockage. Following parathyroid surgery, calcification of the cardiac conduction system improved, leading to reversal of the atrioventricular block. It is important for dialysis patients to optimize intact parathyroid hormone therapy and pay attention to calcification metastasis.
难治性继发性甲状旁腺功能亢进（SHPT）是终末期肾病患者常见的并发症，可导致异位钙化。涉及心脏瓣膜和传导系统的转移性钙化很容易导致心律失常，包括房室传导阻滞。本病例报告描述了一名维持性血液透析患者，其难治性SHPT导致完全性房室传导阻滞（CAVB），最终转变为一度房室传导阻滞。
我们报告一例31岁亚洲女性患者，因狼疮性肾炎接受维持性血液透析。她发生了SHPT，心电图显示一度房室传导阻滞。随后，她接受了甲状旁腺切除术（PTX）并进行了自体移植。不幸的是，几年后，她再次发生SHPT，心电图显示为CAVB。第二次PTX手术后几年，左心房和左心室的钙化情况改善，她的CAVB也得到了逆转。
本病例表明，心脏转移性钙化可导致完全性房室传导阻滞。甲状旁腺手术后，心脏传导系统的钙化情况改善，导致房室传导阻滞逆转。对于透析患者来说，优化完整甲状旁腺激素治疗并关注钙化转移非常重要。
