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放射性心脏病：经导管主动脉瓣置换术与外科主动脉瓣置换术及心包切除术的困境

Radiation-Induced Cardiac Disease: Dilemma of Transcatheter Aortic Valve Replacement vs Surgical Aortic Valve Replacement and Pericardiectomy.

作者信息

Al-Dalakta Astefanos, El Roumi Joseph, Parizher Gary, Tabaja Chadi, Motairek Issam, Ikram Jibran, Ehsan Muhammad, Klein Allan L

机构信息

Center for Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Center for Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.

出版信息

JACC Case Rep. 2025 Jun 25;30(16):104012. doi: 10.1016/j.jaccas.2025.104012.

DOI:10.1016/j.jaccas.2025.104012
PMID:40579075
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12273823/
Abstract

BACKGROUND

Radiation-induced cardiovascular disease, a complication of mediastinal radiation, often results in valvular and pericardial disease. Management is challenging, especially in high-risk patients.

CASE SUMMARY

A 59-year-old man with a history of total body radiation presented with fatigue and dyspnea. Multimodality imaging, including echocardiography, cardiac magnetic resonance, and invasive hemodynamic assessment, confirmed severe aortic stenosis and mild constrictive physiology. Because of an elevated surgical risk and minimum contribution of constrictive physiology to symptoms, the multidisciplinary team opted for transcatheter aortic valve replacement over surgical aortic valve replacement with pericardiectomy.

DISCUSSION

This case underscores the complexities of radiation-induced cardiac disease management, emphasizing the role of multimodality imaging in treatment planning. It highlights transcatheter aortic valve replacement as a viable option for high-risk patients with aortic stenosis in this population.

TAKE-HOME MESSAGE: Multimodality imaging is essential for the management of radiation-induced cardiac disease.

摘要

背景

放射性心血管疾病是纵隔放疗的一种并发症，常导致瓣膜和心包疾病。治疗具有挑战性，尤其是在高危患者中。

病例摘要

一名有全身放疗史的59岁男性出现疲劳和呼吸困难。包括超声心动图、心脏磁共振和有创血流动力学评估在内的多模态成像证实存在严重主动脉瓣狭窄和轻度缩窄性生理改变。由于手术风险升高且缩窄性生理改变对症状的影响最小，多学科团队选择经导管主动脉瓣置换术而非行心包切除术的外科主动脉瓣置换术。

讨论

该病例强调了放射性心脏病治疗的复杂性，突出了多模态成像在治疗规划中的作用。它强调经导管主动脉瓣置换术是该人群中高危主动脉瓣狭窄患者的可行选择。

要点

多模态成像对于放射性心脏病的治疗至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b151/12273823/2d0dc669d3aa/gr9.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b151/12273823/c1942fe13c0e/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b151/12273823/7dd467f5c5ea/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b151/12273823/f7a18440e153/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b151/12273823/4ba6540c11a0/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b151/12273823/d7ab2dbf6126/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b151/12273823/c074b8530b90/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b151/12273823/2d0dc669d3aa/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b151/12273823/725bb9c6c563/ga1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b151/12273823/df6cd718aaa3/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b151/12273823/52745cadb59f/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b151/12273823/c1942fe13c0e/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b151/12273823/7dd467f5c5ea/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b151/12273823/f7a18440e153/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b151/12273823/4ba6540c11a0/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b151/12273823/d7ab2dbf6126/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b151/12273823/c074b8530b90/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b151/12273823/2d0dc669d3aa/gr9.jpg

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本文引用的文献

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Pericardial Diseases: International Position Statement on New Concepts and Advances in Multimodality Cardiac Imaging.心包疾病：多模态心脏成像新概念和新进展的国际立场声明。
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Radiation-Induced Cardiovascular Disease: Review of an Underrecognized Pathology.辐射诱导性心血管疾病：一种认识不足的病理学综述。
J Am Heart Assoc. 2021 Sep 21;10(18):e021686. doi: 10.1161/JAHA.121.021686. Epub 2021 Sep 6.
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Outcomes of Patients With Severe Symptomatic Aortic Valve Stenosis After Chest Radiation: Transcatheter Versus Surgical Aortic Valve Replacement.
严重症状性主动脉瓣狭窄患者在胸部放疗后的结局：经导管主动脉瓣置换术与外科主动脉瓣置换术的比较。
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