Original ArticlesSurgical Management of Radiation-Induced Heart Disease
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Clinical Summary
We have encountered 8 patients with radiation-induced heart disease in the last 10 years. The mode of presentation, the nature of the lesions, and the management of the lesions are summarized in Table 1. This does not include all the patients with radiation-induced heart disease seen in our institution and hence does not indicate the true incidence of the problem. There were 6 men and 2 women between the ages of 22 and 67 years at initial presentation. Lymphoma was the most common primary
Spectrum of Disease
Irradiation can affect all of the structures in the heart. The spectrum of disease, the mean dose of radiation, and the time of presentation compiled from large series are shown in Table 2. The pericardium is the most often involved and the conduction system, the least frequently involved. The overall incidence of clinically detectable radiation-induced heart disease is about 5% to 30% depending on the method of diagnosis. Three groups of patients treated with mediastinal irradiation are
Screening Techniques
As radiation-induced heart disease occurs in a substantial number of patients with prior mediastinal irradiation, screening of asymptomatic patients should be considered. The extent to which these patients benefit from systematic screening with electrocardiography, stress test, echocardiography, or cardiac catheterization is controversial. In a series [24] of 25 patients with Hodgkin’s disease evaluated 37 to 144 months after thoracic mantle irradiation, only 1 patient had normal findings. This
Conclusions
Radiation-induced heart disease must be considered in any patient who has had mediastinal irradiation of more than 3,500 cGy and is seen with cardiac symptomatology. Newer radiation techniques with cardiac shielding may decrease the incidence, but physicians will continue to encounter patients with this problem. Pericardial disease is the most common manifestation, and anterior pericardiectomy is advisable when a patient is seen with symptomatic pericardial effusion. Concomitant pericardiectomy
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Cited by (95)
A call to consider an aortic stenosis screening program
2023, Trends in Cardiovascular MedicineEchocardiography and Cardio-Oncology
2019, Heart Lung and CirculationRadiation-Associated Cardiac Disease: More Complicated Than Just Transcatheter Replacement of the Aortic Valve
2019, Cardiovascular Revascularization MedicineRadiation-Associated Cardiac Disease: A Practical Approach to Diagnosis and Management
2018, JACC: Cardiovascular ImagingCitation Excerpt :Because radiation exposure is heterogeneous, patients’ conditions cannot be uniformly managed and often require individualized surgical approaches. Studies of long-term outcomes (with or without cardiac surgery) in patients with RACD demonstrate increased morbidity and mortality (5,15,25,36,52–55). Previous surgical reports have demonstrated various predictors of short-term (constrictive pericarditis, reduced preoperative ejection fraction, longer cardiopulmonary bypass times) and long-term outcomes (radiation dose, duration of radiation, tangential vs. mediastinal) (5,25,36,56).
Rate of Progression of Aortic Stenosis and its Impact on Outcomes in Patients With Radiation-Associated Cardiac Disease: A Matched Cohort Study
2018, JACC: Cardiovascular ImagingCitation Excerpt :Despite differences in LV-SVI between the 2 groups, it was not independently associated with longer-term mortality. Studies of long-term outcomes (with or without cardiac surgery) in radiation heart disease patients are limited but do in fact demonstrate increased morbidity and mortality compared with non-XRT patients (1–5,19–21). Previous surgical reports have demonstrated various predictors of short-term (constrictive pericarditis, reduced preoperative ejection fraction, longer cardiopulmonary bypass times) and long-term outcomes (radiation dose, duration of radiation, tangential vs. mediastinal approach to radiation) (4,19,21,22).