心肌炎后巨型局灶性心肌纤维化随访22年一例  

A Case of Giant Focal Myocardium after Myocarditis Followed up for 22 Years

作　　者：李春锦[1] 汤锡友[2] 

机构地区：[1]江苏省淮安军分区干休所卫生所,江苏淮安223001 [2]解放军第82医院老年病8科,江苏淮安223001

出　　处：《系统医学》2017年第13期48-49,55,共3页Systems Medicine

摘　　要：目的分析1例心肌炎后巨型局灶性心肌纤维化随访情况。方法该次研究选择1例女性患者,1995年因胸闷气急,中等以上强度活动后加重并有前胸部心跳撞击感就诊,目前随访22年,分析其临床资料及随访情况。结果心脏MRI示:左心房的左侧方、左心室的后下壁有一团块病灶,收缩期射血分数略降低。拟诊为心包肿瘤而行左胸开胸探查,见肿块位于左心室后壁心肌内,约10 cm×10 cm×7 cm大小,大结节状、质韧。经仔细探查,肿块来源于心肌。病理切片示:左室后壁心肌纤维化。结论因肿块位于左心室后壁,且范围大,不宜手术切除治疗,遂逐层关胸。嘱其定期复查,随访观察,对症治疗,目前患者症状无明显加重趋势,可爬5层楼,中午不休息时会有下肢肿胀感。心电图、心脏彩超和心脏MRI、CT与之前相比亦无明显改变;冠脉CTA检查冠状动脉未见异常。Objective This paper tries to analyze a case of follow - up situation of giant focal myocardium after myocarditis. Methods A female p a tient was selected as the research object who was admitted in the hospital due to the chest t ightness and stuffiness and the chest heart beat impact after medium or intensified activities in 1995, and this patient was followed up for 22 years from now on, and her clinical data and fol low-up situation were analyzed. Results According to the heart MRI： there was a mass lesion on left side of the left atrium and posterior wall of the left ventricle, systolic ejection fraction decreased slightly. It was to be diagnosed as pericardial tumor and the left chest thoracotomy was done, the tumor was found to be located in the posterior wall of the left ventricle, with the size of about 10 cm／10 cm／7 cm, large nodular, tough quality. After careful exploration, the mass came from the myocardium. Pathological section showed： left ventricular posterior wall presented myocardial fibrosis. Conclusion The lump was located in the posterior wall of the left ventricle, and the size was large, it was not appropriate for surgical resection. Regular review, fol low-up observation, symptomatic treatment were implemented on her, at present , the symptoms of patients were not obviously intensified, and the patient could climb 5 floors, there would be lower extremity swelling without rest at noon. There were no significant changes in electrocardiogram, heart color doppler ultrasound and heart MRI, CT compared with the previous ones; and no abnormalities of coronary artery happened in the coronary CTA examination.

关 键 词：心肌炎 心肌纤维化 随访 

分 类 号：R542.21[医药卫生—心血管疾病]