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Severe mitral regurgitation caused by immobile posterior leaflet after radiotherapy
R A Jones1, R J Hall, A G Fraser
1Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom.
Insights
Thoracic radiotherapy for Ewing sarcoma can cause severe heart valve disease. A child developed pulmonary edema due to mitral regurgitation from an immobilized valve leaflet, requiring replacement.
Area of Science:
- Cardiology
- Pediatric Oncology
- Radiotherapy
Background:
- Thoracic radiotherapy is a common treatment for pediatric cancers like Ewing sarcoma.
- Cardiac complications following radiotherapy can occur, affecting heart function.
- Valvular heart disease is a potential, though less common, sequela of chest radiation.
Observation:
- A pediatric patient treated with thoracic radiotherapy for Ewing sarcoma presented with pulmonary edema.
- The pulmonary edema was attributed to severe mitral regurgitation.
- Transesophageal echocardiography revealed an immobilized posterior mitral valve leaflet as the cause.
Findings:
- This case highlights rapid progression to severe valvular heart disease post-radiotherapy.
- An immobilized mitral valve leaflet represents a novel mechanism for radiation-induced heart valve dysfunction.
- Surgical valve replacement was required to manage the severe mitral regurgitation.
Implications:
- Clinicians should consider cardiac evaluation, including echocardiography, in patients with a history of thoracic radiotherapy presenting with cardiac symptoms.
- Understanding the specific mechanisms of radiation-induced valvular disease can inform preventative strategies and treatment.
- This case underscores the importance of long-term cardiac monitoring for survivors of pediatric cancers treated with chest radiation.
Abstract:
Radiotherapy may affect the heart in several ways. We describe a child who had pulmonary edema caused by severe mitral regurgitation after thoracic radiotherapy for a Ewing sarcoma. Transesophageal echocardiography demonstrated this to be caused by an immobilized posterior leaflet, and valve replacement was necessary. This is the first reported patient with rapid progression to severe valvar disease after radiotherapy and in whom this novel mechanism has been demonstrated.