Department of Medicine, Division of Cardiology, University of California, Los Angeles, Los Angeles, CA 90095, USA.
Cardiovasc Pathol. 2013 Jul-Aug;22(4):303-8. doi: 10.1016/j.carpath.2012.12.005. Epub 2013 Jan 26.
Hodgkin's lymphoma (HL) comprises of 4% of malignancies diagnosed in children from birth to 14 years of age. While overall survival rates have increased, HL survivors can be at risk of late cardiovascular complications from radiotherapy. HL survivors with a history of mediastinal RT have been found to have an increased incidence of myocardial infarction, angina, congestive heart failure, and valvular disorders compared to the general population.
A 33 year old female with a history of HL status post chemotherapy and mediastinal radiation 11 years ago became symptomatic with multivessel coronary artery disease with aggressive progression of her disease despite coronary bypass graft surgery, patch angioplasty of the left main coronary artery (LMCA) with an extracellular bioscaffold, and repeated percutaneous coronary intervention of the LMCA. She eventually underwent orthotopic heart transplant and did well postoperatively.
Histopathological analysis of the explanted heart revealed a variety of sequelae of radiation arteritis, including thrombosis of both native vessels and arterial grafts, intimal hyperplasia and involvement of the bioscaffold in the left main coronary vasculature. The bioscaffold did not contribute significantly to the stenosis within the LMCA.
Our case demonstrates an unusual indication for OHT due to severe refractory radiation induced CAD, as well the wide spectrum of the histopathologic manifestations of radiation induced arteritis.
霍奇金淋巴瘤（HL）占儿童出生至 14 岁时诊断出的恶性肿瘤的 4%。虽然总生存率有所提高，但 HL 幸存者可能面临放疗引起的迟发性心血管并发症的风险。与普通人群相比，有纵隔 RT 病史的 HL 幸存者心肌梗死、心绞痛、充血性心力衰竭和瓣膜疾病的发生率增加。
一位 33 岁的女性，11 年前因 HL 接受化疗和纵隔放疗后出现症状，患有多支冠状动脉疾病，尽管进行了冠状动脉旁路移植术、左主干冠状动脉（LMCA）的细胞外生物支架补丁血管成形术和 LMCA 的重复经皮冠状动脉介入治疗，但疾病仍迅速进展。她最终接受了原位心脏移植，术后恢复良好。
移植心脏的组织病理学分析显示出多种放射血管炎的后遗症，包括原生血管和动脉移植物的血栓形成、内膜增生以及生物支架在左主干冠状动脉血管中的受累。生物支架对 LMCA 内的狭窄没有显著影响。
我们的病例由于严重难治性放射性 CAD 导致需要进行 OHT，以及放射性动脉炎的组织病理学表现的广泛谱，证明了这是一个不常见的适应证。
