Severe bilateral isolated coronary ostial lesions as a rare manifestation of radiation-induced cardiac disease A case report

  • Rationale: With advances in contemporary radiotherapy techniques, and as cancer survival improves, severe isolated coronary ostial disease may develop many years following mediastinal radiotherapy, even in the absence of classical cardiovascular risk factors. Patient concerns: We describe the case of a 73-year-old woman with previous chest radiotherapy for breast cancer who underwent coronary artery bypass graft surgery for severe bilateral coronary ostial lesions. Diagnoses: Coronary angiography demonstrated severe, isolated bilateral coronary ostial lesions. Interventions: The patient underwent urgent coronary artery bypass graft surgery to treat her critical coronary artery disease. Outcomes: Intra-operatively, internal mammary arteries were not amenable to harvesting due to very dense mediastinal adhesions. Therefore, saphenous vein grafts were performed to the left anterior descending, distal left circumflex, obtuse marginal and distal right coronary arteries. The patient made a satisfactory in-hospital recovery, and was subsequently discharged back to her local hospital for rehabilitation. Lessons: Patients successfully treated with mediastinal radiotherapy require careful long-term follow-up for the assessment of radiation-induced coronary artery disease. Importantly, mediastinal irradiation may preclude internal mammary artery utilization, and thus alter the strategy for surgical myocardial revascularization.
Author:Metesh Nalin Acharya, Mohammad El-Diasty, Bastian SchmackGND, Alexander WeymannGND, Ashham Mansur, Aron-Frederik Popov
Pubmed Id:
Parent Title (English):Medicine
Publisher:Lippincott Williams & Wilkins
Place of publication:Baltimore, Md.
Document Type:Article
Year of Completion:2018
Date of first Publication:2018/03/01
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2018/05/22
Tag:cardiac surgery; coronary; irradiation; ostium
Issue:13, e9867
Page Number:2
First Page:1
Last Page:2
Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0