Valvular Heart Disease

  • Ines Paola MonteEmail author
  • Gyanendra Kumar Sharma
Part of the Current Clinical Pathology book series (CCPATH)


Valvular heart diseases (VHD) may be observed in patients with cancer for several reasons, including preexisting valve lesions, radiotherapy, infective endocarditis, and secondary to LV dysfunction. The incidence of VHD is especially in younger survivors treated with thoracic radiotherapy for certain malignancies, such as Hodgkin’s lymphoma and breast cancer. The mechanism of radiation-induced damage to heart valves is not clear and includes diffuse fibro-calcific thickening of the valve. VHD is commonly diagnosed after a long latent period, in the context of clinical symptoms, or suspected on the basis of a new murmur. The evaluation includes identification of anatomical valve abnormalities and valve dysfunction and assessment of the functional consequences of valve dysfunction on the ventricles. Echocardiography is the optimal imaging technique for diagnostic and therapeutic management. Cardiovascular magnetic resonance (CMR) and computed tomography (CT) may be used to assess the severity of VHD, but cardiac CT is mainly useful for detecting extensive calcifications of the ascending aorta. Patients exposed to mediastinal radiotherapy and minimal valve dysfunction require follow-up every 2 to 3 years, with moderate valve disease yearly, and when severe should be assessed for valve surgery.


Valvular heart disease Echocardiography Mediastinal radiotherapy Hodgkin’s lymphoma Breast cancer 


  1. 1.
    Bessell EM, Bouliotis G, Armstrong S, Baddeley J, Haynes AP, O'Connor S, et al. Long-term survival after treatment for Hodgkin's disease (1973-2002): improved survival with successive 10-year cohorts. Br J Cancer. 2012;107(3):531–6.CrossRefGoogle Scholar
  2. 2.
    Early Breast Cancer Trialists' Collaborative Group. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378(9804):1707–16.CrossRefGoogle Scholar
  3. 3.
    Brosius FC 3rd, Waller BF, Roberts WC. Radiation heart disease. Analysis of 16 young (aged 15 to 33 years) necropsy patients who received over 3,500 rads to the heart. Am J Med. 1981;70(3):519–30.CrossRefGoogle Scholar
  4. 4.
    Copeland KA, Hosmane VR, Jurkovitz C, Kolm P, Bowen J, DiSabatino A, et al. Frequency of severe valvular disease caused by mediastinal radiation among patients undergoing valve surgery in a community-based, regional academic medical center. Clin Cardiol. 2013;36:217–21.CrossRefGoogle Scholar
  5. 5.
    Cutter DJ, Schaapveld M, Darby SC, Hauptmann M, van Nimwegen FA, Krol AD, et al. Risk of valvular heart disease after treatment for Hodgkin lymphoma. J Natl Cancer Inst. 2015;107:djv008.CrossRefGoogle Scholar
  6. 6.
    Aleman BM, van den Belt-Dusebout AW, De Bruin ML, van’t Veer MB, Baaijens MH, de Boer JP, et al. Late cardiotoxicity after treatment for Hodgkin lymphoma. Blood. 2007;109(5):1878–86.CrossRefGoogle Scholar
  7. 7.
    Carlson RG, Mayfield WR, Normann S, Alexander JA. Radiation-associated valvular disease. Chest. 1991;99(3):538–45.CrossRefGoogle Scholar
  8. 8.
    Veinot JP, Edwards WD. Pathology of radiation-induced heart disease: a surgical and autopsy study of 27 cases. Hum Pathol. 1996;27(8):766–73.CrossRefGoogle Scholar
  9. 9.
    Brand MD, Abadi CA, Aurigemma GP, Dauerman HL, Meyer TE. Radiation-associated valvular heart disease in Hodgkin’s disease is associated with characteristic thickening and fibrosis of the aortic-mitral curtain. J Heart Valve Dis. 2001;10(5):681–5.PubMedGoogle Scholar
  10. 10.
    Katz NM, Hall AW, Cerqueira MD. Radiation induced valvulitis with late leaflet rupture. Heart. 2001;86(6):E20.CrossRefGoogle Scholar
  11. 11.
    Tamura A, Takahara Y, Mogi K, Katsumata M. Radiation-induced valvular disease is the logical consequence of irradiation. Gen Thorac Cardiovasc Surg. 2007;55(2):53–6.CrossRefGoogle Scholar
  12. 12.
    Nadlonek NA, Weyant MJ, Yu JA, Cleveland JC Jr, Reece TB, Meng X, et al. Radiation induces osteogenesis in human aortic valve interstitial cells. J Thorac Cardiovasc Surg. 2012;144:1466–70.CrossRefGoogle Scholar
  13. 13.
    Hering D, Faber L, Horstkotte D. Echocardiographic features of radiation-associated valvular disease. Am J Cardiol. 2003;92:226–30.CrossRefGoogle Scholar
  14. 14.
    Hull MC, Morris CG, Pepine CJ, Mendenhall NP. Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of Hodgkin lymphoma treated with radiation therapy. JAMA. 2003;290:2831–7.CrossRefGoogle Scholar
  15. 15.
    Heidenreich PA, Hancock SL, Lee BK, Mariscal CS, Schnittger I. Asymptomatic cardiac disease following mediastinal irradiation. J Am Coll Cardiol. 2003;42(4):743–9.CrossRefGoogle Scholar
  16. 16.
    Wethal T, Lund MB, Edvardsen T, Fosså SD, Pripp AH, Holte H, et al. Valvular dysfunction and left ventricular changes in Hodgkin’s lymphoma survivors. A longitudinal study. Br J Cancer. 2009;101:575–81.CrossRefGoogle Scholar
  17. 17.
    Malanca M, Cimadevilla C, Brochet E, Iung B, Vahanian A, Messika-Zeitoun D. Radiotherapy-induced mitral stenosis: a three-dimensional perspective. J Am Soc Echocardiogr. 2010;23(1):108.e1–2.CrossRefGoogle Scholar
  18. 18.
    van Nimwegen FA, Schaapveld M, Janus CP, Krol AD, Petersen EJ, Raemaekers JM, et al. Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk. JAMA Intern Med. 2015;175(6):1007–17.CrossRefGoogle Scholar
  19. 19.
    Murbraech K, Wethal T, Smeland KB, Holte H, Loge JH, Holte E, et al. Valvular dysfunction in lymphoma survivors treated with autologous stem cell transplantation: a national cross-sectional study. JACC Cardiovasc Imaging. 2016;9(3):230–9.CrossRefGoogle Scholar
  20. 20.
    Boekel NB, Boekel NB, Schaapveld M, Gietema JA, Russell NS, Poortmans P, et al. Cardiovascular disease risk in a large, population-based cohort of breast cancer survivors. Int J Radiat Oncol Biol Phys. 2016;94(5):1061–72.CrossRefGoogle Scholar
  21. 21.
    Cella L, Liuzzi R, Conson M, D'Avino V, Salvatore M, Pacelli R. Multivariate normal tissue complication probability modeling of heart valve dysfunction in Hodgkin lymphoma survivors. Int J Radiat Oncol Biol Phys. 2013;87:304–10.CrossRefGoogle Scholar
  22. 22.
    McGale P, Darby SC, Hall P, Adolfsson J, Bengtsson NO, Bennet AM, et al. Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden. Radiother Oncol. 2011;100(2):167–75.CrossRefGoogle Scholar
  23. 23.
    Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2014;15:1063–93.CrossRefGoogle Scholar
  24. 24.
    Gujral DM, Lloyd G, Bhattacharyya S. Radiation induced valvular heart disease. Heart. 2016;102(4):269–76.CrossRefGoogle Scholar
  25. 25.
    Bottinor WJ, Migliore CK, Lenneman CA, Stoddard MF. Echocardiographic assessment of cardiotoxic effects of cancer therapy. Curr Cardiol Rep. 2016;18(10):99.CrossRefGoogle Scholar
  26. 26.
    Krapf L, Dreyfus J, Cueff C, Lepage L, Brochet E, Vahanian A, et al. Anatomical features of rheumatic and non-rheumatic mitral stenosis: potential additional value of three-dimensional echocardiography. Arch Cardiovasc Dis. 2013;106(2):111–5.CrossRefGoogle Scholar
  27. 27.
    Crestanello JA, McGregor CG, Danielson GK, Daly RC, Dearani JA, Orszulak TA, et al. Mitral and tricuspid valve repair in patients with previous mediastinal radiation therapy. Ann Thorac Surg. 2004;78:826–31.CrossRefGoogle Scholar
  28. 28.
    Beohar N, Kirtane AJ, Blackstone E, Waksman R, Holmes D, Minha S, et al. Trends in complications and outcomes of patients undergoing transfemoral transcatheter aortic valve replacement: experience from the PARTNER Continued Access Registry. JACC Cardiovasc Interv. 2016;9:355–63.CrossRefGoogle Scholar
  29. 29.
    Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739–91.CrossRefGoogle Scholar
  30. 30.
    Cuomo JR, Sharma GK, Conger PD, Weintraub NL. Novel concepts in radiation-induced cardiovascular disease. World J Cardiol. 2016;8(9):504–19.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of General Surgery and Medical-Surgery Specialities, University of CataniaCataniaItaly
  2. 2.Division of CardiologyMedical College of GeorgiaAugustaUSA

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