CORONARY-ARTERY AND AORTIC-VALVE DISEASE AS A LONG-TERM SEQUEL OF MEDIASTINAL AND THORACIC IRRADIATION

Mediastinal and thoracic irradiation has been identified as a risk fac tor for the development of, among other things, coronary artery diseas e (CAD) and valvular disease. We screened all patients for a history o f mediastinal or thoracic radiotherapy. Between 01.07.1989 and 31.12.1 995 we identified 33/16364 patients with such a history. In 19 cases ( 0.12%) the cardiac disease was considered radiation-induced, nine pati ents were female, ten were male. Mean age was 51.7 years (range 38-73) . All 19 patients displayed proximal coronary artery stenoses. Mean ag e in the CAD group was significantly lower (48.5, range 38-63) than in the valvular group (mean age 64.0, range 55-73). The mean interval si nce radiotherapy in the valvular group was significantly longer (22.25 years, range 13-32) than the one in the CAD group (12.2 years, range 7-24). All patients were treated surgically and made an uneventful rec overy. Some form of mediastinal fibrosis or pericardial adhesions was present in all patients. We conclude from these findings that radiatio n-induced cardiac disease is infrequently encountered in patients from a large surgical center. However, especially the radiation-induced co ronary artery disease displays a specific pattern of stenosis location .