Heart diseases following mediastinal irradiation: surgical management

Abstract

Twelve patients underwent cardiac surgical procedures after havingpreviously received irradiation of the mediastinum for various types ofmalignancies (Hodgkin's disease, carcinoma of the breast and seminoma). Thepatients' ages ranged from 39 to 69 years (mean 57 years); nine patientswere female and three male. The average length of time from radiation tosurgery was 15 years (3-24 years interval). The patients were divided intotwo groups according to the type of heart disease: Group I included sevenpatients who developed coronary artery disease (CAD) despite minimal riskfactors. Three asymptomatic patients developed sudden myocardialinfarction. In two patients the myocardial infarction was complicated (withventricular septal defect in one and ventricular septal defect plusventricular aneurysm in the other). All seven patients were surgicallymanaged. Internal thoracic artery (ITA) was used in three patients as aconduit of myocardial revascularization. There were two hospital deaths inthis group. The five patients in Group II underwent aortic valvereplacement for aortic stenoses. Prior to the irradiation, none of thepatients had a documented history of rheumatic fever, bacterialendocartitis, significant murmur, etc. There were no deaths in this group.Intraoperative findings for both groups included thickening and/or fibrosisof the ascending aortic wall, coronary arteries and aortic valve tissue.Epicardium was whitish colored and thickened.