Radiation-Associated Valvular Disease*

Carlson, Robert G.; Mayfield, William; Normann, Sigurd J.; Alexander, James A.

doi:10.1378/chest.99.3.538

Cited by 180 publications

(95 citation statements)

References 27 publications

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“…7) Coronary artery disease induced by radiation therapy was first reported in 1991. 8) Ng argued that screening for coronary artery disease by coronary computed tomography angiography should be performed in survivors of Hodgkin lymphoma who have undergone mediastinal radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Radiation-Induced Coronary Artery Disease Manifested at Very Late Phase

et al. 2017

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SummaryWe report the case of a 51-year-old female, in whom coronary artery disease such as occlusion of septal perforators was manifested, on the occasion of hospitalization with congestive heart failure. The patient had a history of radiation therapy for a mediastinal tumor 19 years previously. As she had no conventional coronary risk factors, the cause of the coronary artery disease is thought to have been related to the radiation therapy. As survival rates of cancer patients improve as a consequence of therapeutic advances, we should be aware of the possibility of coronary artery disease as a very late complication of radiation therapy, even in patients who have no coronary risk factors.(Int Heart J 2017; 58: 993-997) Key words: Radiation therapy, Very late complication, Cardiovascular complication, Heart failure R adiation therapy has an important role as a mode of therapy for malignant tumors. When the irradiation is performed for lung, breast, or esophageal cancer, or for mediastinal tumors such as malignant lymphoma, other intrathoracic organs including the heart are also exposed to the radiation. This can cause coronary artery disease, constrictive pericarditis, valvular disease, and cardiomyopathy in the late stages.1) As the survival rates of intrathoracic malignant neoplasms have been improved by recent therapeutic developments, radiationinduced cardiovascular disease may become more common. Here we report a case with coronary artery disease manifested 19 years after radiation therapy for a mediastinal tumor. Case ReportA 51-year-old female suspected of having congestive heart failure was admitted to our hospital. She had a history of a mediastinal tumor, where information of histopathological diagnosis was absent, but she had received radiation therapy at a total dose of 64.8 Gy ( Figure 1A, B), 19 years previously. She had been experiencing palpitations and shortness of breath for six months, during which time the symptoms had gradually worsened. She had also been having attacks of nocturnal dyspnea at increasing frequency for the past month. On admission, her heart failure symptoms corresponded to New York Heart Association (NYHA) Class III. Her temperature, heart rate, and blood pressure were 36.1ºC, 120 beats/minute, and 148/94 mmHg, respectively. Jugular venous dilatation and edema of the lower extremities were absent. Blood oximetric oxygen saturation was 92% when breathing room air. A Levine II/VI pansystolic murmur and third heart sound were audible maximally at the apex.At admission, a chest roentgenogram showed mild pulmonary congestion and elevation of the left diaphragm, but no cardiomegaly (Figure 2A). An electrocardiogram had showed regular sinus rhythm and narrow QRS complex waves 3 years before ( Figure 2B), but complete left bundle branch block was present at admission. Figure 2C shows the electrocardiogram 2 days after admission. Blood cell counts and clinical chemistry were within the normal range, including levels of total cholesterol, triglycerides, and hemoglobin A1c (187 mg/dL,...

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Section: Discussionmentioning

confidence: 99%

Radiation-Induced Coronary Artery Disease Manifested at Very Late Phase

et al. 2017

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“…Additionally, cancer therapy is a well-known risk factor for succeeding cardiac pathologies, probably necessitating later surgery. 8) In our study, we examined the impact of previous breast cancer on perioperative outcome parameters in cardiac surgery patients undergoing bypass surgery and combined CAGB procedures. For this purpose, breast cancer patients were matched to a control group, compensating biometrics, procedural risk stratification according to Euro-SCORE II and extent of aortic stenosis, if present.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Surgery is Safe in Female Patients with a History of Breast Cancer

Leistner

Sommer

Aleksić

et al. 2016

ATCS

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“…Conventional surgical management for these patients such as coronary bypass surgery and/or valvular heart surgery have been reported [3,8,10,12, 141. One recent study regarding coronary bypass grafting after MRT demonstrated good short-term results, but intermediate results were limited by a recurrent malignancy and/or heart failure [8].…”

Section: Discussionmentioning

confidence: 99%

“…A range of findings can characterize the pathophysiology of the late effects of MRT on the heart: pericardial disease, conduction disturbance, myocardial fibrosis, valvular heart disease, and coronary artery disease [l]. Surgical treatment by pericardiectorny, coronary artery bypass surgery, and valvular heart surgery has been reported in this patient population [3,8,10,12,141. Although Abbreviations FEV, Forced expiratory ventilation at 1 s .…”

Section: Introductionmentioning

confidence: 99%

Heart transplantation for radiation-associated end-stage heart failure

Handa¹,

McGregor²,

Daly³

et al. 2000

Transplant Int

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Radiation-induced heart disease is an increasingly recognized late sequela of mediastinal radiation therapy for malignant neoplasms. We report four cases of heart transplantation for end-stage heart failure induced by mediastinal radiation therapy. Short-term and intermediate-term results are excellent with all four patients currently surviving a mean of 48 months after transplantation. Neither a second malignancy nor recurrence of the primary malignancy has been observed to date. The early results of heart transplantation for end-stage, radiation-induced heart disease are encouraging.

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Radiation-Associated Valvular Disease*

Cited by 180 publications

References 27 publications

Radiation-Induced Coronary Artery Disease Manifested at Very Late Phase

Radiation-Induced Coronary Artery Disease Manifested at Very Late Phase

Cardiac Surgery is Safe in Female Patients with a History of Breast Cancer

Heart transplantation for radiation-associated end-stage heart failure

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