Abstract
Curing lymphoma, breaking the heart - multimodality imaging for valvular heart disease secondary to mediastinal irradiation
Highlights
Hodgkin’s lymphoma (HL) has an annual incidence of 3 per 100.000 persons and became a curable disease with survival rates close to 95%, but the cardiovascular complications due to mediastinal irradiation are an important long-term treatment related morbidity, and the second cause of late mortality after second malignancy[1]
The present case is an illustration of the echocardiographic findings of radiotherapy related valvular disease, with fibrosis and calcification of the aortic root and aortic valve cusps, mitral valve annulus and the base and mid portions of the mitral valve leaflets, but with sparing the mitral valve tips and commissures
The ostial lesions of coronary arteries are frequent after radiotherapy for HL, the most exposed being the left main stem and ostial segments of the circumflex and right coronary arteries
Summary
Hodgkin’s lymphoma (HL) has an annual incidence of 3 per 100.000 persons and became a curable disease with survival rates close to 95%, but the cardiovascular complications due to mediastinal irradiation are an important long-term treatment related morbidity, and the second cause of late mortality after second malignancy[1]. The identified relative risk of fatal cardiovascular events is between 2.2 and 12.7, an absolute excess risk of mortality from 9.3 to 28 per 10,000 person-years of follow-up and a 4.9-fold increase in risk of heart failure in survivors of HL1,2,3. Radiotherapy-induced valvular heart disease affects approximately 10% of treated patients, occurs especially at cumulative doses larger than 30 Gy and has a median time to diagnosis of 22 years[7,8,9,10]. It includes fibrosis and calcification of the aortic root, aortic valve cusps, mitral valve annulus and the base and mid portions of the mitral valve leaflets[11]
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