Orzan F, Brusca A, Conte M R, Presbitero P, Figliomeni M C
Istituto di Medicina e Chirurgia Cardiovascolare, Università degli Studi di Torino, Italy.
Br Heart J. 1993 Jun;69(6):496-500. doi: 10.1136/hrt.69.6.496.
To define the clinical and angiographic features and the therapeutic problems in patients with coronary artery disease after therapeutic irradiation of the chest.
An observational retrospective study.
The cardiac catheterisation laboratory, university medical school.
15 subjects (8 men and 7 women, aged 25-56 years, mean 44) examined in the cardiac catheterisation laboratory, who had significant coronary artery disease years after having radiation treatment to the chest and anterior mediastinum. In the early stages of the study angiography was performed because of typical symptoms of ischaemic heart disease. Later on it was performed because of a high index of suspicion in people with signs of extensive radiation heart damage.
Clinical and electrocardiographic evidence of ischaemic heart disease; echocardiographic signs of pericardial, myocardial or valvar involvement; angiographic evidence of coronary arterial stenosis, with special attention to the ostia; haemodynamic and angiographic signs of pericardial, myocardial, and valvar disease. Survival and symptomatic and functional status were ascertained after medical or surgical treatment.
The patients were relatively young and had no risk factors. Seven patients had no signs or symptoms of ischaemic heart disease. Ten patients had ostial stenosis, which was associated with extensive involvement of other cardiac structures in nine of them. Seven required surgical treatment for coronary artery disease. Two died, one at surgery and the other one six months later. Five patients had complications associated with irradiation.
Coronary arterial disease can be reasonably ascribed to the effects of chest irradiation when the patients are young and free from risk factors, especially if the obstructions are ostial and there is important damage to other cardiac structures. In patients with damage to other cardiac structures angina and infarction are often absent and coronary angiography seems to be mandatory. Patients often require surgical treatment and postoperative complications are common.
明确胸部治疗性放疗后冠心病患者的临床及血管造影特征以及治疗问题。
一项观察性回顾研究。
大学医学院的心导管实验室。
在心导管实验室接受检查的15名受试者（8名男性和7名女性，年龄25 - 56岁，平均44岁），他们在胸部和前纵隔接受放射治疗数年之后患有严重的冠状动脉疾病。在研究早期，因缺血性心脏病的典型症状而行血管造影。后来，对有广泛放射性心脏损伤体征的患者，因高度怀疑而行血管造影。
缺血性心脏病的临床和心电图证据；心包、心肌或瓣膜受累的超声心动图征象；冠状动脉狭窄的血管造影证据，特别关注开口处；心包、心肌和瓣膜疾病的血流动力学和血管造影征象。经药物或手术治疗后确定生存率以及症状和功能状态。
患者相对年轻且无危险因素。7名患者无缺血性心脏病的体征或症状。10名患者有开口处狭窄，其中9名伴有其他心脏结构的广泛受累。7名患者因冠状动脉疾病需要手术治疗。2名患者死亡，1名死于手术，另1名在6个月后死亡。5名患者有与放疗相关的并发症。
当患者年轻且无危险因素时，冠状动脉疾病可合理归因于胸部放疗的影响，尤其是当梗阻位于开口处且其他心脏结构有重要损伤时。在其他心脏结构受损的患者中，心绞痛和梗死往往不存在，冠状动脉造影似乎是必要的。患者常需要手术治疗且术后并发症很常见。
