Bilateral isolated coronary ostial stenosis following mediastinal irradiation.

Division of Cardiac Surgery, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
Asian cardiovascular & thoracic annals 04/2004; 12(1):78-80.
Source: PubMed

ABSTRACT Isolated coronary ostial narrowing is rare and may represent a separate disease entity from atherosclerotic coronary artery disease. The case of a 41-year-old female with no coronary risk factors who developed severe bilateral isolated coronary ostial stenosis following mantle radiotherapy for Hodgkin's disease is described. She underwent urgent coronary artery bypass grafting and has remained well for 3 years.

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    ABSTRACT: Mediastinal irradiation can induce coronary artery disease characterized by the localization of lesions at the proximal segment of the arteries. We report the case of a 17-year-old patient who underwent a mediastinal irradiation for pulmonary sarcoma and developed 15 years later an asymptomatic ischemic cardiopathy. Bilateral coronary ostial stenosis was discovered by a transthoracic echography and coronary angiography showed isolated bilateral ostial stenosis. Coronary bypass grafting was performed with internal thoracic arteries. We recommend testing exercise and echocardiography during follow-up of patients who have received more than 30 Gy of mediastinal radiation. Surgery is the treatment of choice in bilateral ostial stenosis using internal thoracic arteries in young patients if preoperative assessment shows patency.
    Journal of Cardiac Surgery 01/2006; 21(6):600-2. · 1.35 Impact Factor
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    ABSTRACT: Ostial coronary artery disease is rare with a reported incidence of 0.07 to 0.25% in all patients undergoing angiography. It has a strong association with previous mediastinal irradiation, which induces specific histological changes distinct from atherosclerotic lesions. The radiation also affects the myocardium and surrounding structures, which can alter the surgical approach. We present a case of a 62-year-old female who developed bilateral ostial coronary artery stenosis 32 years following therapeutic radiotherapy for Hodgkin's disease. She underwent successful coronary artery bypass surgery using a combination of arterial and venous conduits. Postoperatively she developed a clinical picture of diastolic impairment not detected pre-operatively. She was managed appropriately and made a successful recovery. This case highlights the cardiac pathology associated with mediastinal irradiation, which should be suspected during surgical assessment, especially in long-term survivors. It heightens the surgeon's awareness so a more thorough evaluation of coronary anatomy, ventricular function and potential conduits is made prior to surgery.
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