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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 To analyze the follow-up of giant focal fibrosis after one case of myocarditis. Methods One female patient was selected in this study. In 1995, her chest tightness and agitation, aggravating after middle and upper intensity activities and her anterior thoracic heart attack, were followed up for 22 years. The clinical data and follow-up were analyzed. Results of cardiac MRI: left atrium on the left side of the left ventricular posterior inferior wall has a mass lesion, systolic ejection fraction slightly lower. To be diagnosed as pericardial tumor line left chest thoracotomy exploration, the mass is located in the posterior wall of the left ventricular myocardium, about 10 cm × 10 cm × 7 cm size, large nodular, qualitative tough. After careful exploration, the mass comes from the myocardium. Pathological section showed: left ventricular posterior myocardial fibrosis. Conclusion The mass is located in the posterior wall of the left ventricle, and the scope is not suitable for surgical resection and treatment. Instruct its regular review, follow-up observation, symptomatic treatment, the current symptoms of patients no significant increase in the trend can climb 5 floors, no rest at noon will have a sense of lower limb swelling. ECG, echocardiography and cardiac MRI, CT and no significant change compared to before; coronary CTA showed no abnormal coronary artery.