Severe left main coronary stenosis and mitral regurgitation in a young female patient without cardiovascular risk factors 14 years after mediastinal radiation therapy

Templin, Christian; Ghadri, Jelena-Rima; Wyss, Christophe; Lüscher, Thomas F.; Kaufmann, Philipp A.; Landmesser, Ulf

doi:10.1007/s00392-009-0103-4

Clin Res Cardiol

2009

DOI: 10.1007/s00392-009-0103-4

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Severe left main coronary stenosis and mitral regurgitation in a young female patient without cardiovascular risk factors 14 years after mediastinal radiation therapy

Christian Templin

Jelena-Rima Ghadri

Christophe Wyss

et al.

Abstract: Ulf (2009). Severe left main coronary stenosis and mitral regurgitation in a young female patient without cardiovascular risk factors 14 years after mediastinal radiation therapy. Clinical Research in Cardiology:Epub ahead of print.

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“…In particular, CAD may occur up to 30 years after radiation therapy [19,20]. Interestingly, such lesions are frequently localized at ostial or proximal coronary segments, which may be due to their superior and anterior location of the arteries directly in the radiation field, while the distal parts of the coronary arteries are usually unaffected [9,[20][21][22][23]. Because patients with severe CAD might be asymptomatic due to concomitant radiationrelated nerve impairment, cardiologists should be highly alert for symptoms of CAD even in young patients without conventional atherogenic risk factors, who previously underwent mediastinal radiotherapy.…”

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Severe left main coronary stenosis in a young female patient, 6 years after mediastinal radiation therapy for non-Hodgkin lymphoma: assessment by coronary angiography and intravascular ultrasound

et al. 2012

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Sirs:Due to advances in chemo-and radiotherapy over the last decades, a considerable amount of patients with malignant Hodgkin and non-Hodgkin lymphomas become long-term survivors [1][2][3]. However, cardiovascular complications, especially in patients who undergo mediastinal radiotherapy with potential exposure of cardiac structures, represent a significant cause of long-term mortality [4,5]. Data on cardiac morbidity show that a diverse cardiac pathology can be found in this patient cohort, including conduction abnormalities, valvular, pericardial and coronary artery disease (CAD) [4][5][6][7]. Hereby, the microvascular pathology is characterized by a decrease in capillary density [8], causing chronic myocardial ischemia and fibrosis in experimental models. Macrovascular disease on the other hand, usually occurs through an accelerated development of age-related atherosclerosis and frequently involves ostial lesions of the left main and of the right coronary artery, resulting in an increased risk for non-fatal myocardial infarction or sudden cardiac death [9].A 34-year-old woman with stable angina and suspected CAD was referred to our institution for coronary angiography in December 2010. None of the established atherogenic risk factors were present. A history of primary mediastinal diffuse large B-cell non-Hodgkin lymphoma was present, which was diagnosed in 2003, and was treated with 6 courses of rituximab added to cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy at that time. Due to tumor relapse after R-CHOP treatment, autologous stem cell transplantation was performed in 2004, followed by mediastinal radiotherapy. Complete remission of the disease was noted thereafter. At the time of presentation in our department in December 2010, the patient exhibited typical angina and dyspnoea on exertion, and an ambulatory stress-ECG exhibited inducible ST segment depression of 0.3 mV in the leads V3-V6. Laboratory findings including parameters for renal function, serum electrolytes, C-reactive protein, N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and high-sensitive troponin T were within the normal range. Furthermore, echocardiography showed no valve disorders and no conduction abnormalities were seen in the ECG.Left ventricular (LV)-angiography during cardiac catheterization showed normal left-ventricular function. Coronary angiography revealed a severe ostial stenosis of the left main coronary artery, which remained after the intracoronary administration of 0.4 mg nitroglycerin (Fig. 1a). Coronary atherosclerosis was also observed in the mid circumflex coronary vessel without causing flow-limiting stenosis. No other significant lesions were observed (Fig. 1a-c). In order to verify the extent and localization of the observed left main lesion, intravascular ultrasound (IVUS) was subsequently performed (iLab Ultrasound Imaging System, Boston Scientific, MA, USA), exhibiting the presence of a large fibrotic plaque in the ostium of the left main coronary artery (Fig. 2a, ...

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Severe left main coronary stenosis in a young female patient, 6 years after mediastinal radiation therapy for non-Hodgkin lymphoma: assessment by coronary angiography and intravascular ultrasound

et al. 2012

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Severe left main coronary stenosis and mitral regurgitation in a young female patient without cardiovascular risk factors 14 years after mediastinal radiation therapy

Abstract: Ulf (2009). Severe left main coronary stenosis and mitral regurgitation in a young female patient without cardiovascular risk factors 14 years after mediastinal radiation therapy. Clinical Research in Cardiology:Epub ahead of print.

Cited by 1 publication

References 11 publications

Severe left main coronary stenosis in a young female patient, 6 years after mediastinal radiation therapy for non-Hodgkin lymphoma: assessment by coronary angiography and intravascular ultrasound

Severe left main coronary stenosis in a young female patient, 6 years after mediastinal radiation therapy for non-Hodgkin lymphoma: assessment by coronary angiography and intravascular ultrasound

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