Aquino-Bruno Heberto, Muratalla-González Roberto, Garcia-Garcia Juan F, Morales-Portano Julieta D, Meléndez-Ramírez Gabriela, Ahu-Chandomi Yusihey, Merino-Rajme Jose A, Alcantara-Meléndez Marco A
Interventional Cardiology Service, Centro Médico Nacional 20 de Noviembre, Av. Felix Cuevas #540, Col. Del Valle Del. Benito Juarez, Mexico City 03100, Mexico.
Echocardiography Service, Centro Médico Nacional 20 de Noviembre, Av. Felix Cuevas #540, Col. Del Valle Del. Benito Juarez, Mexico City 03100, Mexico.
Eur Heart J Case Rep. 2024 Sep 3;8(9):ytae475. doi: 10.1093/ehjcr/ytae475. eCollection 2024 Sep.
The coexistence of aortic stenosis (AS) and neoplastic pathology are common due to shared risk factors with atherosclerotic disease, such as diabetes, inflammatory conditions, and smoking. Severe AS in patients with cancer requires careful assessment in order to select the appropriate therapeutic choices and their timing (i.e. valve treatment first vs. cancer treatment first).
A 66-year-old woman with a history of smoking was admitted to our centre due to heart failure (HF). During her hospitalization, severe AS with severe ventricular dysfunction and cancer were documented. Because of her severe heart disease, she was unable to receive antineoplastic treatment. Therefore, she underwent percutaneous surgery to treat the aortic valve. After that, the management of cancer became possible, which included bilateral radical mastectomy and chemotherapy.We are presenting a case of cancer coexisting with aortic stenosis and reduced left ventricle ejection fraction. In this case, we performed Transcatheter Aortic Valve Replacement (TAVR) with the aim of improving the ejection fraction, followed by chemotherapy.
Cancer patients may be further disadvantaged by AS if it interferes with their treatment by increasing the risk associated with oncologic surgery and compounding the risks associated with cardiotoxicity and HF. Clinical trials and guidelines on TAVR exclude cohorts with limited life expectancy. Hence, the correct and optimal care for cancer patients with severe AS is complex. The TAVR, for cancer patients with severe AS, can more frequently be the best clinical choice by avoiding cardiopulmonary bypass, minimal invasiveness, and therefore, shorter recovery time.
由于与动脉粥样硬化疾病存在共同的风险因素，如糖尿病、炎症性疾病和吸烟，主动脉瓣狭窄（AS）与肿瘤性病变并存的情况很常见。癌症患者中的重度AS需要仔细评估，以便选择合适的治疗方案及其时机（即先进行瓣膜治疗还是先进行癌症治疗）。
一名有吸烟史的66岁女性因心力衰竭（HF）入住我们中心。在住院期间，记录到存在重度AS伴严重心室功能障碍和癌症。由于她患有严重的心脏病，无法接受抗肿瘤治疗。因此，她接受了经皮手术治疗主动脉瓣。此后，癌症的治疗成为可能，包括双侧根治性乳房切除术和化疗。我们正在介绍一例癌症与主动脉瓣狭窄及左心室射血分数降低并存的病例。在本病例中，我们进行了经导管主动脉瓣置换术（TAVR），目的是提高射血分数，随后进行化疗。
如果AS干扰癌症患者的治疗，增加与肿瘤手术相关的风险，并加重与心脏毒性和HF相关的风险，那么癌症患者可能会因AS而进一步处于不利地位。关于TAVR的临床试验和指南排除了预期寿命有限的队列。因此，对重度AS癌症患者的正确和最佳护理很复杂。对于重度AS的癌症患者，TAVR通过避免体外循环、微创性以及因此更短的恢复时间，更经常地可以成为最佳的临床选择。
