Late radiation-induced cardiovascular disease after childhood rhabdomyosarcoma: a case report

Radiation-induced cardiovascular disease may appear decades after cancer therapy and can involve multiple vascular, valvular, myocardial, and conduction structures of the heart. Management is particularly challenging when prior irradiation results in a hostile chest environment and impaired wound healing.

A 31-year-old woman with a history of childhood right forearm rhabdomyosarcoma treated with resection, chemotherapy, and radiotherapy presented with recurrent syncope. Computed tomography angiography revealed asymmetric growth of the right-sided arteries, leading to a transient ischaemic attack. Further cardiovascular evaluation revealed multiple concomitant cardiovascular disorders, including valvular heart disease, high-grade atrioventricular block, bradycardia, and heart failure. Permanent pacemaker implantation and right-to-left axillary artery bypass prevented further syncopal episodes; however, heart failure continued to worsen. Two years later, she was hospitalized with severe heart failure and dyspnoea, and echocardiography revealed aortomitral continuity calcification and elevated filling pressure. She subsequently underwent the Bentall procedure, tricuspid valve replacement, and coronary artery bypass grafting for advanced coronary stenosis. However, her postoperative course was complicated by pleural effusion and haemoptysis, and she eventually died of multiorgan dysfunction.

This case illustrates the late cardiovascular effects of radiation therapy. Radiation-induced endothelial injury, fibrosis, and maladaptive wound-healing responses may contribute to delayed cardiovascular damage and poor postoperative recovery. In such patients, surgical decision-making should be multidisciplinary, and long-term follow-up is essential.