Transplantacija srca 28 let po končanem zdravljenju ne-Hodgkinovega limfoma v otroštvu Heart transplant 28 years after completed treatment for non-Hodgkin’s lymphoma in childhood

case report

Abstract

Pri bolnikih, ki so se zdravili zaradi raka v otroštvu, so okvare kardiovaskularnega sistema med poglavitnimi vzroki pozne umrljivosti, ki je sedem-krat večja kot pri splošni populaciji. Najpogostejši vzrok komplikacij na srcu pri bolnikih z rakom so antraciklini ki sodijo med najučinkovitejša zdravila neoplastičnih bolezni. Pri opisu primera našega bolnika želimo opozoriti na napredujočo okvaro srčne mišice po zdravljenju ne-Hodgkinovega limfoma s kemoterapijo, ki je vsebovala antracikline in alkilirajoče agense, in je 28 let po končanem zdravljenju privedla do odpovedi srca, zaradi katere je bila potrebna transplantacija srca.
Pri bolnikih, zdravljenih z antracikini, je zelo pomembno doživljenjsko sledenje funkcije srca, da vsako motnjo (tudi klinično nemo) na srcu čim prej odkrijemo in ustrezno zdravimo. Ehokardiografija je najpogosteje uporabljena diagnostična metoda za ocenjevanje delovanja srca v okviru sledenja poznih posledic zdravljenja s citostatiki in/ali obsevanjem. Zelo pomembno je morebitne okvare najti v fazi, ko je bolnik še asimptomatski, saj lahko z ustreznim zdravljenjem (predvsem ACE inhibitorji in beta-blokatorji) in ustreznim načinom življenja in zmanjševanjem drugih dejavnikov tveganja za razvoj kardiovaskularnih obolenj preprečimo oz. upočasnimo razvoj življenje ogrožujoče okvare srca.

Abstract (Eng)

In patients, who have received cancer treatment in childhood, the damages of the cardiovascular system are among the primary causes for later mortality, which is seven times higher than in general population. The most frequent cause for heart complications in cancer patients are anthracycline, which are the most effective medications for neoplastic diseases. In our patient case report we wish to draw attention to the advanced heart muscle defect after treatment of non-Hodgkin’s lymphoma with chemotherapy, which included anthracyclines and alkaline agents, after 28 years resulted in heart failure and required a heart transplant. In patients treated with anthracyclines, lifetime active monitoring of their cardiac function is crucial, so that any heart disturbances (also clinically silent) are discovered as soon as possible and treated accordingly. Echocardiography is the most frequently used diagnostic method for heart function evaluation within the scope of monitoring subsequent consequences of cytostatic treatment and/or radiation. It is very important that any potential defects are discovered at a stage when the patient is still asymptomatic, because appropriate treatment (mainly ACE inhibitors and beta blockers), appropriate lifestyle, as well as minimising other risks for developing cardiovascular disease can prevent or delay the development of a life-threatening heart defect.