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Case Reports
. 2022 Nov 3:8:101672.
doi: 10.1016/j.jaccas.2022.08.049. eCollection 2023 Feb 15.

A Rare Case of Radiation-Associated Aortic and Mitral Valve Stenosis Treated With Transcatheter Valve Replacements

Logan S Schwarzman  1 , Nichelle Megowan  1 , Venkat S Manubolu  2 , Sonia U Shah  1   2
Affiliations
Case Reports

A Rare Case of Radiation-Associated Aortic and Mitral Valve Stenosis Treated With Transcatheter Valve Replacements

Logan S Schwarzman et al. JACC Case Rep. .

Abstract

Radiation therapy is the standard of care for achieving cure for many thoracic malignancies, but it can result in long-term cardiovascular sequelae such as valve disease. We describe a rare case of severe aortic and mitral stenosis due to prior radiation therapy for giant cell tumor treated successfully with percutaneous aortic and off-label mitral valve replacements. (Level of Difficulty: Intermediate.).

Keywords: AV, aortic valve; CT, computed tomography; LVOT, left ventricular outflow tract; MV, mitral valve; TAVR, transcatheter aortic valve replacement; TMVR, transcatheter mitral valve replacement; TTE, transthoracic echocardiography; aortomitral curtain; radiation therapy; valve stenosis.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Index Electrocardiography The index electrocardiogram revealed sinus rhythm with left atrial enlargement, left ventricular hypertrophy, right-axis deviation, and no significant conduction abnormalities.
Figure 2
Figure 2
Index Transthoracic Echocardiography Parasternal long-axis view showing calcification of the aortic and mitral valves with the hallmark feature of extension to the aortomitral curtain (arrows), consistent with radiation-associated valve disease.
Figure 3
Figure 3
Cardiac Computed Tomography (A) Multiplanar reconstruction demonstrating severe calcification of the aortic and mitral valves with concomitant aortomitral curtain calcification. (B) Multiplanar reconstruction of left ventricular outflow tract (LVOT) dimension in short-axis view is important to position the mitral valve and minimize the risk of developing an outflow tract gradient. The interventional team deployed the transcatheter aortic valve replacement because the struts of the transcatheter mitral valve replacement may land within the LVOT. LA = left atrium; LV = left ventricle; RV = right ventricle.
Figure 4
Figure 4
Cardiac Computed Tomography Volume-rendering 3-dimensional reconstruction with the use of cardiac computed tomography demonstrating aortomitral calcification.
Figure 5
Figure 5
Pre-Implantation Transesophageal Echocardiography (A) Multiplanar imaging of the mitral valve revealed a mitral valve area of 1.0 cm2 by 3-dimensional planimetry. There is heavy calcification of the annulus, leaflets, and aortomitral curtain. (B) Multiplanar imaging of the aortic valve shows a trileaflet valve with severe cusp calcification, consistent with transthoracic echocardiography finding of severe aortic stenosis.
Figure 6
Figure 6
Postimplantation Fluoroscopy Transcatheter atrial valve replacement and off-label transcatheter mitral valve replacement deployed via a transapical approach using a transcatheter heart valve in both positions.
See this image and copyright information in PMC

References

    1. Gujral D., Lloyd G., Bhattacharyya S. Radiation-induced valvular heart disease. Heart. 2016;102(4):269–276. - PubMed
    1. Desai M., Windecker S., Lancellotti P., et al. Prevention, diagnosis, and management of radiation-associated cardiac disease: JACC Scientific Expert Panel. J Am Coll Cardiol. 2019;74(7):905–927. - PubMed
    1. Iliescu C., Grines C., Herrmann J., et al. SCAI expert consensus statement: evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory. Catheter Cardiovasc Interv. 2016;87(5):e202–e223. - PubMed
    1. Dijos M., Reynaud A., Leroux L., et al. Efficacy and follow-up of transcatheter aortic valve implantation in patients with radiation-induced aortic stenosis. Open Heart. 2015;2(1) - PMC - PubMed
    1. Nielsen K., Offersen B., Nielsen H., Vaage-Nilsen M., Yusuf S. Short and long term radiation induced cardiovascular disease in patients with cancer. Clin Cardiol. 2017;40(4):255–261. - PMC - PubMed

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