lA 74-year-old woman presented with severe tricuspid incompetence 25 years after radiation therapy of the chest for left-sided breast cancer. The dose given could not be evaluated, but due to a technical defect it had been much too high. There was also a large radiation ulcer of the chest wall. The transthoracic echocardiograph (Fig 1⇓) showed thickening of all the heart valve structures, especially the ones close to the anterior chest wall, right and left ventricular dysfunction, and severe tricuspid incompetence. During catheterization, we found occlusions of the left anterior descending artery and the proximal part of the right coronary artery, the sites of the occlusions also being close to the anterior chest wall (Figs 2⇓ and 3⇓). There was left ventricular anteroapical dyskinesia (Fig 4⇓), right ventricular inferior akinesia, and hypokinesis of the other right ventricular segments (Fig 5⇓). The patient improved with diuretics. Cardiac surgery was not taken into consideration due to the poor condition of the chest wall.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner, MC 4-265, Houston, TX 77030.
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