Copyright © 1988 by the European Society of Cardiology.
© 1988 The European Society of Cardiology
Post-radiotherapeutic left main coronary ostial stenosis: clinical and histological study
*Service de Cardiologie, CHU Cote de Nacre 14033 Caen Cedex, France
Service de Chirurgie Thoracique et Cardiovasculaire, CHU Cote de Nacre 14033 Caen Cedex, France
Laboratoire d'Anatomo-Pathologie, CHU Cote de Nacre 14033 Caen Cedex, France
Received 27 July 1987; revised 30 October 1987; .
Author for correspondence. Docteur G. Grollier, Service de Cardiolo-gre, CHU Cote de Nacre, 14033 Caen Cedex, France.
Abstract
Pericardial abnormalities remain the most common manifestation of radiation-induced cardiac disease, but coronary artery lesions are not rare. In this report we describe a left coronary ostial stenosis which appeared five years after mediastinal irradiation for breast carcinoma in a 50-year-old woman. The patient underwent coronary angiography. A pressure drop was observed as the left catheter tip engaged the left coronary ostium; so, only nonselective coronary opacifications were performed showing an isolated, marked narrowing of the left coronary ostia. During surgery, a circumferential aortotomy allowed the examination of the left coronary ostium which appeared severely stenosed. The coronary tree was otherwise normal. A termino-terminal saphenous vein graft was anastomosed on the left stem and its proximal part was implanted on the ascending aorta. The coronary ostium and the proximal part of the left main stem were excised and the macroscopic examination of the proximal part of the left coronary artery confirmed the diagnosis of severe ostial stenosis. Microscopic examination of the coronary ostium showed a severe intimal thickening without any evident lesion of the media. This intimal thickening consisted of fibrous tissue without extracellular lipid deposit. Microscopic examination of the aorta near the coronary ostium also demonstrated an intimal thickening without any lesion of the media. Coronary ostial stenosis appears to be a rare lesion; its incidence has varied between 0·13 and 2·7% in angiographic studies and there is co-existing disease in multiple coronary vessels in the majority of cases. This coronary lesion in a middle-aged woman after a mediastinal irradiation, its histologic aspect (pure intimal fibrous thickening), and the secondary appearance of complete atrio-ventricular block, fits the pattern previously ascribed to radiotherapy. Only two other cases of coronary ostial lesion almost certainly secondary to mediastinal irradiation have been reported.
Key Words: Ostial stenosis • radiotherapy • surgical treatment
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  P. A. Heidenreich, I. Schnittger, H. W. Strauss, R. H. Vagelos, B. K. Lee, C. S. Mariscal, D. J. Tate, S. J. Horning, R. T. Hoppe, and S. L. Hancock Screening for Coronary Artery Disease After Mediastinal Irradiation for Hodgkin's Disease J. Clin. Oncol., January 1, 2007; 25(1): 43 - 49. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Mahajan, G. Hollander, B. Malik, B. Temple, D. Thekkoott, S. Abrol, N. Schulhoff, J. Ghosh, J. Shani, and E. Lichstein Isolated and Significant Left Main Coronary Artery Disease: Demographics, Hemodynamics and Angiographic Features Angiology, August 1, 2006; 57(4): 464 - 477. [Abstract] [PDF]
|
|
|
|
 |
|
 R. Waksman, B. Bhargava, G. S. Mintz, R. Mehran, A. J. Lansky, L. F. Satler, A. D. Pichard, K. M. Kent, and M. B. Leon Late total occlusion after intracoronary brachytherapy for patients with in-stent restenosis J. Am. Coll. Cardiol., July 1, 2000; 36(1): 65 - 68. [Abstract] [Full Text] [PDF]
|
|