Waqar Salman, Jutley Rajwinder, Mount Richard, Sarkar Pradip
Department of Cardiothoracic Surgery, Northern General Hospital Sheffield Teaching Hospitals NHS Trust, Sheffield, S5 7AU UK.
Cases J. 2009 Aug 25;2:7792. doi: 10.4076/1757-1626-2-7792.
Ostial coronary artery disease is rare with a reported incidence of 0.07 to 0.25% in all patients undergoing angiography. It has a strong association with previous mediastinal irradiation, which induces specific histological changes distinct from atherosclerotic lesions. The radiation also affects the myocardium and surrounding structures, which can alter the surgical approach.
We present a case of a 62-year-old female who developed bilateral ostial coronary artery stenosis 32 years following therapeutic radiotherapy for Hodgkin's disease. She underwent successful coronary artery bypass surgery using a combination of arterial and venous conduits. Postoperatively she developed a clinical picture of diastolic impairment not detected pre-operatively. She was managed appropriately and made a successful recovery.
This case highlights the cardiac pathology associated with mediastinal irradiation, which should be suspected during surgical assessment, especially in long-term survivors. It heightens the surgeon's awareness so a more thorough evaluation of coronary anatomy, ventricular function and potential conduits is made prior to surgery.
冠状动脉开口处疾病较为罕见，在所有接受血管造影的患者中，其报告发病率为0.07%至0.25%。它与既往纵隔放疗密切相关，纵隔放疗会引发与动脉粥样硬化病变不同的特定组织学变化。放疗还会影响心肌及周围结构，进而可能改变手术方式。
我们报告一例62岁女性，在接受霍奇金病治疗性放疗32年后出现双侧冠状动脉开口处狭窄。她接受了动脉和静脉导管联合的冠状动脉搭桥手术，手术成功。术后她出现了术前未检测到的舒张功能障碍临床表现。经适当治疗后，她成功康复。
该病例凸显了与纵隔放疗相关的心脏病理情况，在手术评估时应予以怀疑，尤其是对长期存活者。这提高了外科医生的意识，以便在手术前对冠状动脉解剖结构、心室功能和潜在导管进行更全面的评估。
