Radiation-Associated Pulmonary Infundibular Stenosis:A case report Shinsuke Kamada 1 , Masashi Horimoto 1 , Hitoki Inoue 1 , Takashi Takenaka 1 1Division of Cardiology, Sapporo National Hospital Keyword: 肺動脈漏斗部狭窄症 , 放射線照射 , 心エコー図 , pulmonary infundibular stenosis , radiation therapy , echocardiogram pp.941-944
Published Date 1995/9/15
DOI https://doi.org/10.11477/mf.1404901124
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A case of pulmonary infundibular stenosis due to radiation is presented. A 68-year-old female was ad-mitted to the hospital for evaluation of cardiac murmur. She had had a radical mastectomy for the left breast cancer at the age of 45 years and subsequently received mediastinal radiation with an electron beam. First total radiation doses to the upper and lower medias-tinum were 51 Gy, respectively ; second total radiation doses to the same portions were 57 Gy, respectively. At the age of 59 years, pericardial effusion due to radiation-associated pericarditis was noted but no cardiac mur-mur was heard. She had been free from symptoms during the long clinical course of her illness.

Physical examination on admission showed systolic ejection murmur of grade 3/6 at the Erb area, normal blood pressure of 134/82 mmHg and normal sinus rhyth-m of 74 beats/min. B-mode echocardiography showed pericardial effusion contiguous to the posterior wall of the left ventricle and no asynergy and no hypertrophy of the left ventricular wall. No valvular dysfunction was detected. The right ventricular (RV) outflow tract was strikingly narrowed at systole because of the hyper-contraction of the thickened RV free wall at the RV outflow tract. Doppler echocardiography revealed a turbulent flow with a pressure gradient of 12 mmHg at the RV outflow tract. A similar pressure gradient was noted by RV pressure study, which showed 32/0 mmHg (end-diastolic pressure 4 mmHg) at the RV, 17/4 mmHg at the RV outflow tract, and 20/6 mmHg (mean pressure 11 mmHg) at the pulmonary artery. Right ventriculography revealed a systolic narrowing of the RV outflow tract and coronary angiograms were nor-mal.

The cardiac murmur heard 21 years after the radia-tion therapy, the chronic pericardial effusion and the pressure gradient at the RV outflow tract, associated with thickened RV free wall at the RV infundibulum, suggest that the pulmonary infundibular stenosis was caused by mediastinal radiation. Radiation-associated pulmonary infundibular stenosis is a rare entity and is recognized as a late cardiac involvement after a large dose of chest radiation.

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