Chest
Volume 99, Issue 3, March 1991, Pages 538-545
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Radiation-Associated Valvular Disease*

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The prevalence of radiation-associated cardiac disease is increasing due to prolonged survival following mediastinal irradiation. Side effects of radiation include pericarditis, accelerated coronary artery disease, myocardial fibrosis and valvular injury. We evaluated the cases of three young patients with evidence of significant valvular disease following mediastinal irradiation. One patient underwent the first reported successful aortic and mitral valve replacement for radiation-associated valvular disease (RAVD) as well as concurrent coronary artery revascularization. A review of the literature revealed 35 reported cases of RAVD, with only one successful case of valve replacement that was limited to the aortic valve. Asymptomatic RAVD is diagnosed 11.5 years after mediastinal irradiation compared with 16.5 years for symptomatic patients, emphasizing that long-term follow-up is important for patients receiving mediastinal irradiation. This study defines a continuum of valvular disease following radiation that begins with mild asymptomatic valvular thickening and progresses to severe valvular fibrosis with hemodynamic compromise requiring surgical intervention. (Chest 1991; 99:538–45)

Section snippets

Aortic and Mitral Valve Replacement with Coronary Artery Bypass Grafting Following Mediastinal Irradiation

An 18-year-old white male subject was in good health until March 1974 when he was diagnosed as having embryonal cell carcinoma of the testicle. He underwent unilateral adrenalectomy and right radical retroperitoneal node dissection with evidence of nodal metastasis. Postoperatively, he received chemotherapy (chlorambucil, dactinomycin, and methotrexate) and simultaneous supervoltage radiation therapy using the inverted Y format to the mantle, paraaortic, and femoral regions with a total

Radiation-Associated Valvular Disease

Surgical intervention for RAVD has been reported in five patients (Table 1). However, in one patient, surgery was abandoned because of extensive mediastinal fibrosis and in a second patient, aortic valve replacement could not be performed because of extensive aortic calcification. In the latter patient, a valve conduit was placed between the left ventricle and descending aorta to temporarily bypass a severely stenotic aortic valve. Thus, the cases of only three patients have been reported who

CONCLUSION

RAVD begins with minimal valvular thickening and progresses to hemodynamically significant valvular injury. The mean age at diagnosis of asymptomatic RAVD is 11.5 years after therapy, and it is most often established by echocardiography. Symptomatic valvular disease usually presents as congestive heart failure and is diagnosed at a mean age of 16.5 years after therapy. Left-sided valvular lesions predominate, with aortic and mitral valves being equally involved. Chemotherapy may potentiate

REFERENCES (32)

  • WardaM et al.

    Radiation-induced valvular dysfunction

    J Am Coll Cardiol

    (1983)
  • DetranoRC et al.

    Two-dimensional echocardiographic assessment of radiation-induced valvular heart disease

    Am Heart J

    (1984)
  • HarrisAL et al.

    Myocardial ischaemia, radiotherapy, and vinblastine

    Lancet

    (1981)
  • AmrominGD et al.

    The synergism of X-irradiation and cholesterol-fat feeding on the development of coronary artery lesions

    J Atheroscler Res

    (1964)
  • StewartJR et al.

    Radiation-induced heart disease: an update

    Prog Cardiovasc Dis

    (1984)
  • StewartJR et al.

    Radiation-induced heart disease: a study of 25 patients

    Radiology

    (1967)
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