Coronary Artery and Aortic Valve Disease as a Long-Term Sequel of Mediastinal and Thoracic Irradiation

Abstract

Mediastinal and thoracic irradiation has been identified as a risk factor for the development of among other things, coronary artery disease (CAD) and valvular disease. We screened all patients for a history of mediastinal or thoracic radiotherapy. Between 01.07.1989 and 31.12.1995 we identified 33/16,364 patients with such a history. In 19 cases (0.12%) the cardiac disease was considered radiation-induced, nine patients were female, ten were male. Mean age was 51.7 years (range 38-73). All 19 patients displayed proximal coronary artery stenoses. Mean age in the CAD group was significantly lower (48.5, range 38-63) than in the valvular group (mean age 64.0, range 55-73). The mean interval since radiotherapy in the valvular group was significantly longer (22.25 years, range 13-32) than the one in the CAD group (12.2 years, range 7-24). All patients were treated surgically and made an uneventful recovery. Some form of mediastinal fibrosis or pericardial adhesions was present in all patients. We conclude from these findings that radiation-induced cardiac disease is infrequently encountered in patients from a large surgical center. However, especially the radiation-induced coronary artery disease displays a specific pattern of stenosis location.