Boulay G, Debaene B
Service d'anesthésie, institut Gustave-Roussy, Villejuif, France.
Ann Fr Anesth Reanim. 1998;17(1):43-6. doi: 10.1016/s0750-7658(97)80181-5.
We describe a case of postoperative congestive heart failure in a young woman of physical class ASA 1, following breast cancer surgery. Preoperatively she had been treated with doxorubicin (Adriamycin) 450 mg.m-2, total dose, associated with breast and ovarian radiotherapy. This association was probably the cause of postoperative heart failure. Twenty-four hours after surgery, a two-dimensional echocardiography showed a severe left ventricular dysfunction, whereas preoperative clinical assessment was unremarkable. Doxorubicin cardiotoxicity can be acute, subacute and delayed as in our case. Clinical assessment and ECG are not sensitive indicators of such cardiac damage. Preoperative echography is the technique of choice for the evaluation of the cardiac status of a patient treated with a high cumulative dose of doxorubicin and mediastinal irradiation.
我们描述了一例美国麻醉医师协会（ASA）身体状况分级为1级的年轻女性在乳腺癌手术后发生术后充血性心力衰竭的病例。术前她接受了总量为450 mg.m-2的阿霉素（多柔比星）治疗，并接受了乳腺和卵巢放疗。这种联合治疗可能是术后心力衰竭的原因。术后24小时，二维超声心动图显示严重的左心室功能障碍，而术前临床评估并无异常。阿霉素心脏毒性可如我们病例中所示为急性、亚急性和延迟性。临床评估和心电图并非此类心脏损伤的敏感指标。术前超声检查是评估接受高累积剂量阿霉素和纵隔照射患者心脏状况的首选技术。
