Surgical management of radiation-induced heart disease.
BACKGROUND
With the increasing population of patients with prior mediastinal irradiation, cardiac surgeons will encounter patients with radiation-induced damage to the heart and the great vessels. Awareness of the pathology and the surgical management is essential to provide optimal care for these patients.


METHODS
Eight patients with radiation-induced heart disease were encountered in the last 10 years. After a brief clinical presentation, the surgical management of radiation-induced heart disease is reviewed.


RESULTS
Radiation can affect all the structures in the heart, including the coronary arteries, the valves, and the conduction system. The pericardium is the most commonly involved, and the conduction system is the least involved. Pericardiectomy is quite effective in patients with symptomatic pericardial effusion or constriction. The coronary lesions are located predominantly in the ostial or proximal regions of the epicardial vessels. Percutaneous transluminal coronary angioplasty alone appears to have a high rate of restenosis. Surgical revascularization has good long-term results, and the internal mammary artery should be used if it is satisfactory. The aortic and mitral valves are more commonly involved than the tricuspid and pulmonary valves. Myocardial dysfunction predominantly affects the right ventricle and requires particular attention during cardiopulmonary bypass and in the postoperative period. Restoration of sinus rhythm is essential in view of stiffness of the ventricles. Flexibility in the surgical approach with selective use of thoracotomy will facilitate the surgical procedure in certain patients.


CONCLUSIONS
Surgeons should be well versed in all the manifestations and the management of radiation-induced heart disease.
Veeragandham
R S
RS
Department of Cardiovascular and Thoracic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.
Goldin
M D
MD
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001021:Aortic Valve / Q000528:radiation effects / Q000601:surgery; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000601:surgery; D002315:Cardiopulmonary Bypass; D003327:Coronary Disease / Q000209:etiology / Q000601:surgery / Q000628:therapy; D003331:Coronary Vessels / Q000528:radiation effects; D005260:Female; D006329:Heart Conduction System / Q000528:radiation effects; D006331:Heart Diseases / Q000209:etiology / Q000601:surgery*; D006349:Heart Valve Diseases / Q000209:etiology / Q000601:surgery; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008137:Longitudinal Studies; D008297:Male; D008479:Mediastinal Neoplasms / Q000532:radiotherapy; D008875:Middle Aged; D008943:Mitral Valve / Q000528:radiation effects / Q000601:surgery; D010347:Patient Care Planning; D010490:Pericardial Effusion / Q000209:etiology / Q000601:surgery; D010492:Pericardiectomy; D010494:Pericarditis, Constrictive / Q000209:etiology / Q000601:surgery; D010496:Pericardium / Q000528:radiation effects; D011664:Pulmonary Valve / Q000528:radiation effects; D011832:Radiation Injuries / Q000209:etiology / Q000601:surgery*; D011878:Radiotherapy / Q000009:adverse effects; D012008:Recurrence; D013899:Thoracic Neoplasms / Q000532:radiotherapy; D013908:Thoracotomy; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000528:radiation effects; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000601:surgery