Chest
Radiation-Associated Valvular Disease*
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)
Symptomatic constrictive pericarditis developing 45 years after radiation therapy to the mediastinum: as review of radiation pericarditis
Am Heart J
(1969)- et al.
Management of patients with radiation-induced pericarditis with effusion: a note on the development of aortic regurgitation in two of them
Chest
(1973) Effusive-constrictive radiation pericarditis: two cases illustrating value of angiocardiography in diagnosis
Am J Cardiol
(1967)- et al.
Radiation induced coronary artery disease
J Am Coll Cardiol
(1986) - et al.
Clinical and angiographic features of coronary artery disease after chest irradiation
Am J Cardiol
(1987) - et al.
Radiation-related chronic heart disease
Chest
(1983) - et al.
Radiation heart disease: analysis of 16 young (aged 15 to 33 years) necrospy patients who received over 3,500 rads to the heart
Am J Med
(1981) - et al.
Coronary artery disease following mediastinal radiation therapy
J Thorac Cardiovasc Surg
(1983) - et al.
Coronary heart disease after mediastinal irradiation for Hodgkin's disease
Am J Med
(1976) Radiation induced coronary artery disease
Chest
(1977)