Acquired infundibular pulmonary stenosis. Possible late complication following radiotherapy of Hodgkin disease

A case of infundibular pulmonary stenosis occurring years after a mediastinal radiation for Hodgkin's disease is reported. As far as the literature is known to us, a similar case has not yet been described. It is most likely that the development of the stenosis is due to the radiation therapy, since a murmur was not heard before radiation and a mild stenosis was proved several years after radiation. Now, a high gradient with the typical signs of an infundibular pulmonary stenosis was present. Unfortunately the patient refused the operation. Further possibilities for acquired pulmonary stenosis and cardial complications after mediastinal radiation for Hodgkin's disease will be discussed.     

Bilateral coronary ostial stenosis and aortic valvular disease after radiotherapy

A 44-year-old woman with a history of chest radiotherapy developedostial coronary artery disease associated with aortic valvulardisease and a lesion of the right internal mammary artery.     

Screening for latent coronary artery disease by fluoroscopic detection of calcium in the coronary arteries

In a population comprised of patients with symptomatic coronary artery disease (CAD), it has been shown that the sensitivity and specificity of conventional fluoroscopy for detection of stenosis is good when age and extent of calcium are considered.¹ However, because coronary angiography is difficult to justify in the absence of active CAD, only the predictive value of a positive fluoroscopic test has been reported in asymptomatic subjects. ^2,3 Moreover, the influence of gender, age, and number of arteries calcified has not been examined in this group. To clarify the potential of fluoroscopy for detecting latent CAD and to assess the effect of age, sex and severity of calcium on its diagnostic efficacy, we studied patients undergoing coronary arteriography for nonischemic heart disease who had no evidence of concomitant CAD.     

误诊为冠心病的甲状腺功能减退性心脏病一例

1病例资料 患者男性,62岁,因“反复胸闷1年,加重1月”入院。胸闷位于心前区,本人手掌大小范围,伴冷汗,无心悸、气促、抽搐、晕厥,持续3～5min后稍缓解,伴肌肉僵硬、疼痛,声音低哑。反复发作,多于劳累、感冒时发作,休息后可缓解。     

Diagnosis of critical stenosis of the coronary arteries in patients with ischemic heart disease

Possible diagnosis of critical coronary stenosis using a bicycle ergometry along with coronary angiography was studied in 193 patients. Informative hemodynamic criteria were proposed for noninvasive diagnosis of anatomic critical coronary stenosis during exercise. Application of coronary angiography combined with a bicycle ergometric testing enabled the true critical coronary stenosis to be diagnosed.     

Multiple fistulae of coronary arteries to both ventricles

A 74 year old man was found at necropsy to have multiple coronary arteriosystemic fistulae involving all three major coronary arteries and both ventricles. This is the second such case reported. All terminal branches of the coronary arteries entered the myocardium and numerous tiny vessels opened into the cardiac chambers. No coronary veins or coronary sinus were recognized. This vascular anomaly is considered to result from the abnormal persistence of intertrabecular spaces within the embryonic myocardium.     

Ubiquitous atherosclerosis in coronary arteries without angiographically significant stenosis

Previous intravascular ultrasound (IVUS) studies have shown coronary artery atherosclerosis even in angiographically normal reference segment. However, IVUS has not been performed in all of the three major coronary arteries. A total of 50 patients with single-vessel disease underwent IVUS evaluation in the proximal two-thirds of the three major coronary arteries. Lumen and external elastic membrane cross-sectional areas were measured at 1-mm intervals. To compensate the difference in pullback length among coronary arteries, normalized total plaque and media volume (TPV) was calculated as TPV/number of slices in pullback × median number of slices in study population. Percent plaque and media volume (PPV) was calculated as TPV/Σ external elastic membrane cross-sectional area × 100. A cross section was defined as atherosclerotic if maximum intimal thickness exceeded 0.5 mm at any point in the vessel circumference. There was no significant difference in normalized TPV, PPV, and the incidence of abnormal intimal thickness between coronary arteries with and without significant stenosis. Frequency distribution of plaque burden was similar. Atherosclerosis is ubiquitous even in coronary arteries without angiographically significant stenosis. The extent of atherosclerosis is similar between coronary arteries with and without significant stenosis.     

Prospects in the treatment of stenosis of the coronary arteries

Treatment of stenosis of coronary arteries has progressed considerably since the introduction of angioplasty by Grüntzig. There are three problems associated with angioplasty: reocclusion, restenosis and extension of indications. To solve these problems, a good many techniques designed to flatten or destroy the plaque have been developed. Hemoperfusion balloons can be used to treat reocclusion by prolonged inflation and may reduce the rate of restenosis. Methods for assisting blood circulation (CPS or hemopump) extend the indications for angioplasty to inoperable patients. Stents hold the vessel open and hence prevent reocclusion. They can be useful for stenosis of shunts but in general are thrombogenic and have not proved efficacious in preventing restenosis. Laser-heated metal probes (hot tips) generate spasm and thrombosis. Lasers are now used to heat balloons which allow reattachment of grafts and reduction of restenosis. The excimer appears more promising. Atheroma is currently the subject of some interest and atherectomy has proved feasible, but the indications are as yet undefined. Although new techniques have introduced the possibility of treating certain reocclusions, none has proved effective in prevention of restenosis. The multiplicity of instruments currently available allows gradual extension of the indications for angioplasty.     

Diagnostic value of CT angiography in coronary arteries stenosis detection

BACKGROUND: Noninvasive imaging of coronary arteries is very important. CT angiography (multislice computed tomography and electron beam computed tomography -- MSCT and EBT) is most reliable method for noninvasive coronary visualization. PURPOSE: The aim of our study was to evaluate the diagnostic value of CT angiography in coronary arteries stenoses detection in patients with coronary arteries disease (CAD). MATERIALS AND METHODS: 140 patients with CAD who underwent EBT (n=97) or 4-slice CT (n=43) coronary angiography and conventional coronary angiography as a gold standard were included in the study. RESULTS: Sensitivity and specificity of CT angiography in coronary stenoses detection (proximal and mid segments) were 86% and 97%, respectively. Positive and negative predictive values were 90% and 96%, respectively. Overall accuracy was 95%. 6.2% of coronary segments were excluded from the study because of unsatisfactory image quality. CONCLUSIONS: CT angiography is noninvasive method for coronary stenoses detection with high sensitivity and specificity. Nevertheless EBT and 4-slice CT angiography can not replace conventional coronary angiography because of lower temporal and spatial resolution, artifacts in patients with arrhythmias and huge coronary calcification.     

亚临床甲状腺功能减退与冠心病的关系

随着研究的深入,越来越多的证据表明,亚临床甲状腺功能减退(SCH)与冠心病关系密切,SCH可增加冠心病的发病率和死亡率,其可能机制包括导致血脂代谢紊乱、增加氧化应激、血管内皮功能障碍等;此外,还与促进代谢综合征、升高血压、高同型半胱氨酸等冠心病危险因素有关。探讨SCH对冠心病的不良影响,有利于为冠心病的预防提供新思路。本文主要对近年关于SCH与冠心病关系的相关研究做简要综述。     

Corrected transposition of the great arteries masquerading as coronary artery disease

A man with corrected transposition of the great arteries and associated “mitral” and aortic insufficiency survived for 50 years. The patient had angina pectoris and abnormal cardiac contour on chest roentgenogram, and for many years coronary artery disease with ventricular aneurysm was suspected. The correct diagnosis was made by cardiac catheterization and coronary arteriography.     

Intercurrent death after Hodgkin disease therapy in radiotherapy and adjuvant MOPP trials

STUDY OBJECTIVE: To assess long-term differences in mortality associated with initial Hodgkin disease therapy. DESIGN: Retrospective review of patients treated in prospectively randomized clinical trials. PATIENTS: Three hundred twenty-six patients with pathologic stage I, II, or III, A or B Hodgkin disease treated between 1967 and 1980 with median follow-up exceeding 14 years. INTERVENTIONS: Patients at the same stage of disease were randomized to receive radiation alone (167 patients) or radiation followed by 6 cycles of mechlorethamine hydrochloride, vincristine, procarbazine, and prednisone (MOPP) chemotherapy (159 patients) with additional therapy for progression or recurrence. MEASUREMENTS AND MAIN RESULTS: No significant differences between treatment regimens for actuarial survival, intercurrent disease, or Hodgkin disease mortality were seen. Thirty-three patients who received radiation alone and 30 patients who received adjuvant chemotherapy died without evident Hodgkin disease. Death was caused by second neoplasms in 28 patients (relative risk, 2.35; 95% CI, 1.46 to 3.24). Six patients developed acute myelogenous leukemia or a myeloproliferative disorder after treatment including MOPP. Chemotherapy exposure varied among the 8 patients with lung cancers, 6 with gastrointestinal and 3 with other adenocarcinomas, 3 with sarcomas, 1 with diffuse large cell lymphoma, and 1 with melanoma. Acute myocardial infarction caused 9 of 17 cardiovascular disease deaths with 5 occurring in patients between the ages of 33 and 43. Nonetheless, the risk for acute myocardial infarction was not clearly increased (relative risk, 0.86; 95% CI, 0.42 to 1.57). Fifteen patients died from infection: 5, opportunistic; 5, asplenic sepsis; and 5, other pneumonias. Two patients died in accidents, and 1 died from radiation pneumonitis. CONCLUSIONS: Adjuvant MOPP chemotherapy improved freedom from relapse without significant survival benefit or impairment. Leukemogenesis was the only lethal complication associated with MOPP. Survivors of Hodgkin disease had an increased risk for death from a second neoplasm, but no apparent increased risk for death from acute myocardial infarction.     

Risks and diagnosis of coronary artery disease in Hodgkin lymphoma survivors

Higher mortality rates are reported because of cardiovascular diseases in individuals living in industrialized areas of the World.In cancer patients,cardiotoxic chemotherapeutic agents and/or mediastinal radiotherapy are additional risk factors for the development of coronary artery disease.An improved survival rate for patients with Hodgkin lymphoma was reported in recent decades.Determining and handling the long-term effects of cancer treatment have become more important nowadays,parallel to the good results reached in survival rates.Mediastinal radiotherapy and cardiotoxic chemotherapeutic agents are routinely used to treat Hodgkin lymphoma but are commonly associated with a variety of cardiovascular complications.Drugs used in cancer treatment and radiotherapy may cause deleterious effects on contractile capacity and conduction system of the heart.Approximately ten years after the completion of all therapies,the cardiovascular disease risk peaks in patients who survived from Hodgkin lymphoma.The value of coronary computed tomography angiography as a diagnostic tool in determining coronary artery disease as early as possible is underlined in this review,in patients who are in remission and carry the risk of coronary artery disease probably because of chemo/radiotherapy used in their treatment.Survivors of Hodgkin lymphoma especially treated with combined chemoradiotherapy at younger ages are candidates for coronary computed tomography angiography.