Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
Department of Infectious Diseases, Tongji Hospital, Tongji Medical College and State Key Laboratory for Diagnosis and Treatment of Severe Zoonostic Infectious Disease, Huazhong University of Science and Technology, Wuhan, Hubei, China.
World J Surg Oncol. 2024 Nov 30;22(1):322. doi: 10.1186/s12957-024-03603-2.
Metastasis of malignant tumors to the cardiac endocardium is rare and mainly involves the right side of the heart. It is extremely rare to involve the left cardiac endocardium, especially when there is neither pulmonary metastasis nor primary lung cancer, which we call "isolated" left cardiac endocardium metastasis in this paper. Few such cases previously reported in the literature were not screened for patent foramen ovale (PFO).
This article reports a case of a young woman with a history of surgery for cervical cancer, who was transferred to our hospital with a suspected diagnosis of PFO after recent recurrent multiple cerebral infarctions. On admission, transthoracic echocardiography revealed multiple stringy vegetations in the left ventricle, which were subsequently removed surgically, with intraoperative confirmation of a patent foramen ovale and closure of it simultaneously. According to her medical history and pathological results, she was diagnosed with left ventricular metastasis of cervical cancer, a rare case of isolated left heart endocardium metastasis without previous pulmonary metastasis, presumably through the patent foramen ovale.
PFO may play an important role in the process of isolated left heart endocardium metastasis in patients with distant malignancies and paradoxical embolism. Screening for PFO in high-risk patients may have significant clinical significance.
恶性肿瘤转移至心脏的心内膜较为罕见,主要累及右侧心脏。累及左侧心内膜则极其罕见,特别是既没有肺部转移也没有原发性肺癌时,我们在本文中称之为“孤立性”左侧心脏心内膜转移。此前文献中报道的少数此类病例并未对卵圆孔未闭(PFO)进行筛查。
本文报告了一例年轻女性,患有宫颈癌病史,因近期反复多发脑梗死而转入我院,疑似患有 PFO。入院时,经胸超声心动图显示左心室有多个条索状赘生物,随后手术切除,术中证实存在卵圆孔未闭,并同时予以关闭。根据她的病史和病理结果,诊断为宫颈癌左心室转移,这是一例罕见的无先前肺部转移的孤立性左侧心脏心内膜转移病例,推测是通过卵圆孔未闭转移的。
PFO 可能在远处恶性肿瘤和反常栓塞患者的孤立性左侧心脏心内膜转移过程中发挥重要作用。对高危患者进行 PFO 筛查可能具有重要的临床意义。