Monte Ines Paola, Cameli Matteo, Losi Valentina, Privitera Fiorella, Citro Rodolfo
Department of General Surgery and Medical-Surgery Specialities, University of Catania, AOU Policlinico Vittorio Emanuele, Catania, Italy.
Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
J Cardiovasc Echogr. 2020 Apr;30(Suppl 1):S26-S32. doi: 10.4103/jcecho.jcecho_5_19. Epub 2020 Apr 10.
Valvular heart diseases (VHD) may be observed in patients with cancer for several reasons, including preexisting valve lesions, radiotherapy, infective endocarditis, and secondary to the left ventricle dysfunction. The incidence of VHD is especially in younger survivors treated with thoracic radiation therapy for certain malignancies, such as Hodgkin's lymphoma and breast cancer. The mechanism of radiation-induced damage to heart valves is not clear and includes diffuse fibrocalcific thickening of the valve. VHD is commonly diagnosed after a long latent period, in the context of clinical symptoms, or suspected on the basis of a new murmur. The evaluation includes identification of anatomical valve abnormalities, valve dysfunction, and assessing the functional consequences of valve dysfunction on the ventricles. Echocardiography is the optimal imaging technique for diagnostic and therapeutic management. Cardiovascular magnetic resonance and computed tomography (CT) may be used to assess the severity of VHD, but cardiac CT is mainly useful for detecting extensive calcifications of the ascending aorta. Patients exposed to mediastinal radiotherapy and minimal valve dysfunction require follow-up of 2-3 years, with moderate valve disease yearly, with severe, should be assessed for valve surgery.
癌症患者可能会因多种原因出现心脏瓣膜疾病(VHD),包括既往存在的瓣膜病变、放疗、感染性心内膜炎以及继发于左心室功能障碍。VHD的发病率尤其在接受胸部放疗的某些恶性肿瘤(如霍奇金淋巴瘤和乳腺癌)的年轻幸存者中较高。放疗导致心脏瓣膜损伤的机制尚不清楚,包括瓣膜的弥漫性纤维钙化增厚。VHD通常在很长的潜伏期后,根据临床症状被诊断出来,或者基于新出现的杂音而被怀疑。评估包括识别解剖学上的瓣膜异常、瓣膜功能障碍,以及评估瓣膜功能障碍对心室的功能影响。超声心动图是诊断和治疗管理的最佳成像技术。心血管磁共振和计算机断层扫描(CT)可用于评估VHD的严重程度,但心脏CT主要用于检测升主动脉的广泛钙化。接受纵隔放疗且瓣膜功能障碍轻微的患者需要随访2 - 3年,中度瓣膜疾病患者每年随访,重度患者应评估是否进行瓣膜手术。