Introduction: The heart and great vessels were once thought to be relatively resistant to the damaging effects of irradiation therapy. There is now clear evidence that thoracic irradiation may cause acute inflammation and progressive fibrosis of the different thoracic structures including coronary arteries and the conduction system. As new therapies have improved survival, many patients with cancer (mostly Hodgkin's disease and breast cancer) are now at risk of cardiovascular (CV) complications of radiation therapy.
Purpose: To raise awareness of CV complications, following chest irradiation.
Methods: We present 3 patients who presented with CV complications after chest irradiation.
First Case: A-42–year-old male was presented with dizziness and 2:1 AV Block 2 years post CABG. Twenty-five years earlier, the patient had been treated with radiotherapy to the mediastinum for Lymphoma. A chest CT revealed calcification of 3 coronary arteries, Aortic root of Aorta, Aortic valve and Mitral Annulus. This patient was treated with permanent pacemaker.
Second Case: A 60–year-old female, who was treated at childhood by radiation therapy to her upper chest and neck for cervial Neuroblastoma, presented with dyspnea at effort, for the past 10 years, with the clinical and laboratory evidence of severe pulmonic stenosis and documented normal coronary arteries. She was successfully treated by pulmonic balloon valvuloplasty.
Third Case: A 56-year-old female, who was treated 2 years earlier by left chest irradiation for breast cancer, complaining of effort angina, had a positive Exercise Test. On heart catheterization there was evidence of two vessel disease – successfully treated by PCI.
Thus, during a short period (less than 2 years) we have met 3 patients who suffered CV involvement, after chest irradiation therapy.
Conclusions: Patients after chest irradiation should be followed periodically, in order to diagnose and treat CV complications.
