Carlson R G, Mayfield W R, Normann S, Alexander J A
Department of Surgery, University of Florida, College of Medicine, Gainesville.
Chest. 1991 Mar;99(3):538-45. doi: 10.1378/chest.99.3.538.
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.
由于纵隔放疗后生存期延长，放射性心脏病的患病率正在上升。放疗的副作用包括心包炎、加速性冠状动脉疾病、心肌纤维化和瓣膜损伤。我们评估了3例纵隔放疗后出现明显瓣膜疾病证据的年轻患者的病例。1例患者接受了首例报道的成功的主动脉和二尖瓣置换术，用于治疗放射性瓣膜疾病（RAVD）以及同期冠状动脉血运重建。文献回顾显示有35例报道的RAVD病例，仅有1例成功的瓣膜置换病例，且仅限于主动脉瓣。无症状RAVD在纵隔放疗后11.5年被诊断出来，而有症状患者为16.5年，这强调了对接受纵隔放疗的患者进行长期随访很重要。本研究定义了放疗后瓣膜疾病的连续过程，始于轻度无症状瓣膜增厚，进展为严重瓣膜纤维化并伴有血流动力学损害而需要手术干预。
