CASE 7-2011: Perioperative challenges of valvular replacement in patients after mediastinal radiation therapy

摘要

Mediastinal radiation therapy can induce a wide spectrum of cardiovascular pathology, and the potential perioperative risks for patients after radiation therapy who require valvular surgery remain underappreciated. These patients frequently present with symptoms consistent with a deterioration in cardiac function despite optimal medical management, and surgical intervention becomes an option to extend and improve quality of life. Interestingly, some of these patients may appear to have normal left ventricular function based on preoperative workup, which may be deceiving to the unfamiliar practitioner when developing an intraoperative management plan. The authors retrospectively reviewed their experience with this delicate subset of patients to collectively identify intraoperative challenges and outcomes.