Oshino Tomohiro, Shikishima Karin, Moriya Yumi, Hosoda Mitsuchika, Kamiya Kiwamu, Nagai Toshiyuki, Anzai Toshihisa, Takahashi Masato
Department of Breast Surgery, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.
Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0034. Epub 2025 Apr 9.
Perioperative mortality is significantly higher in cases of heart failure with severe left ventricular ejection fraction (LVEF) reduction, making it challenging to decide whether to proceed with surgery for early-stage breast cancer, which is not immediately fatal. However, the prognosis of heart failure has improved and breast cancer is increasingly becoming a prognostic factor. Herein, we report the case of a breast cancer patient with severe heart failure due to dilated cardiomyopathy (DC), who was deemed fit to undergo surgery under general anesthesia after obtaining sufficient informed consent and achieving improvement in heart failure symptoms during endocrine therapy.
A 64-year-old female with a history of DC and sustained ventricular tachycardia, who had received cardiac resynchronization therapy with defibrillator implantation, underwent breast cancer surgery. She had been repeatedly hospitalized for heart failure with an LVEF of 19% and New York Heart Association (NYHA) Class III status, and heart transplant surgery was considered. However, a screening computed tomography scan revealed right breast cancer, and neither heart transplantation nor breast cancer surgery was performed. Endocrine therapy was initiated and failed 48 months after administration. Although the LVEF remained low at 21%, the NYHA classification improved to Class II, and she had not been hospitalized for heart failure for an extended period since her breast cancer diagnosis. Therefore, breast cancer surgery was performed under general anesthesia and no postoperative complications were observed throughout the course of the surgery.
Given that the prognosis for heart failure may statistically be better than that for breast cancer, early breast cancer surgery should be performed in patients with stable heart failure symptoms.
在严重左心室射血分数（LVEF）降低的心力衰竭病例中，围手术期死亡率显著更高，这使得对于并非立即致命的早期乳腺癌是否进行手术的决策具有挑战性。然而，心力衰竭的预后已有所改善，乳腺癌日益成为一个预后因素。在此，我们报告一例因扩张型心肌病（DC）导致严重心力衰竭的乳腺癌患者，在获得充分知情同意且内分泌治疗期间心力衰竭症状有所改善后，被认为适合在全身麻醉下接受手术。
一名64岁女性，有DC病史及持续性室性心动过速，已接受心脏再同步化治疗并植入除颤器，接受了乳腺癌手术。她曾因心力衰竭反复住院，LVEF为19%，纽约心脏协会（NYHA）心功能分级为III级，曾考虑进行心脏移植手术。然而，一次筛查计算机断层扫描显示右乳癌，因此既未进行心脏移植也未进行乳腺癌手术。开始内分泌治疗，给药48个月后治疗失败。尽管LVEF仍低至21%，但NYHA分级改善至II级自乳腺癌诊断以来她很长一段时间未因心力衰竭住院。因此，在全身麻醉下进行了乳腺癌手术，整个手术过程未观察到术后并发症。
鉴于心力衰竭的统计学预后可能优于乳腺癌，对于心力衰竭症状稳定的患者应进行早期乳腺癌手术。
