Ellis G R, Penny W J
Department of Cardiology, University Hospital of Wales, Cardiff, UK.
Heart. 1997 Oct;78(4):419-20. doi: 10.1136/hrt.78.4.419.
A 45 year old man presented with a five week history of worsening exertional dyspnoea and orthopnoea. He had also noted mild, bilateral ankle swelling. The patient had been diagnosed with stage III Hodgkin's lymphoma in 1968 at the age of 21. During the same year he underwent total nodal irradiation followed by chemotherapy in 1971. He had remained entirely asymptomatic over the course of the next 24 years with no evidence of relapse. Cardiac catheterisation undertaken soon after admission revealed a tight left main stem stenosis with a left dominant system. Left ventriculogram showed severe, global hypokinesia, and raised left ventricular end diastolic pressure (22 mm Hg). Urgent coronary artery bypass graft surgery was carried out. He made an uncomplicated recovery and his condition improved sufficiently to allow discharge eight days following the procedure. His heart failure slowly resolved and repeat transthoracic echocardiogram performed six months after surgery showed an unequivocal improvement in left ventricular function. Left ventricular ejection fraction continued to improve and increased from 23% at two months to 42% at two years. He currently remains entirely asymptomatic off all medication.
一名45岁男性，有进行性加重的劳力性呼吸困难和端坐呼吸5周病史。他还注意到双侧脚踝轻度肿胀。该患者于1968年21岁时被诊断为III期霍奇金淋巴瘤。同年，他接受了全淋巴结照射，1971年又接受了化疗。在接下来的24年里，他一直完全无症状，无复发迹象。入院后不久进行的心脏导管检查显示左主干严重狭窄，为左优势型系统。左心室造影显示严重的全心运动减弱，左心室舒张末期压力升高（22 mmHg）。紧急进行了冠状动脉搭桥手术。他恢复顺利，术后8天病情改善到足以出院。他的心力衰竭逐渐缓解，术后6个月进行的经胸超声心动图复查显示左心室功能有明显改善。左心室射血分数持续改善，从术后2个月时的23%增加到2年时的42%。他目前在未服用任何药物的情况下仍完全无症状。
