Valvular Heart Disease
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.
KeywordsValvular heart disease Echocardiography Mediastinal radiotherapy Hodgkin’s lymphoma Breast cancer
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