Radiotherapy-induced Aortic Valve Disease

Associated with Porcelain Aorta

Kazuyuki Daitoku, MD, Kozo Fukui, MD, Ikkoh Ichinoseki, MD, Mamoru Munakata, MD, Shoichi
Takahashi, MD, and Ikuo Fukuda, MD

Prepared by : Hala Rabee ID/s1811023

Faculty of graduate studies/medical imaging department

Supervisor : Dr-Hussein Al-Masri

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 Introduction

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 Introduction
• This study report a case of aortic valve replacement
for irradiation- induced aortic valve disease
associated with extensive calcification of the
ascending aorta and proximal arch (porcelain aorta)

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 Case study
• 59-year old woman (weight 52.7 kg) was
admitted to Hirosaki University Hospital.

dyspnea palpitations

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 Case study
• Laboratory investigations
• Electrocardiogram
revealed complete atrioventricular (AV) block(a
permanent pacemaker was implanted via the left
subclavian vein)
• Cardiac catheterization
revealed aortic valve stenosis (AS) with a mean
pressure gradient 40 mmHg, third degrees of aortic
regurgitation (AR), and 75% stenosis of the proximal
segment of the right coronary artery (RCA)
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 Case study
• Echocardiography
demonstrated severe calcification of the
tricuspid valve and mild mitral regurgitation.

• Chest computed tomography (CT)

revealed severe calcification of the ascending
aorta and proximal aortic arch (porcelain
aorta).
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 Case study

Computed tomography (CT) showed severe

calcification of the proximal aortic arch
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 Case study

severe calcification of the ascending

aorta (porcelain aorta)
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 Treatment
Aortic valve surgery was performed in May
2001

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 Discussion
 Mediastinal irradiation is known to induce cardiac
damage
 In the case presented, irradiation- induced
stenosis was apparent in the proximal segment of
the RCAs
 Damaged valves by irradiation are more prone to
causing trauma in the high-pressured left ventricle
than those in the right ventricle, leading to a
higher incidence of left-side valvular dysfunction.

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 Discussion
 Conduction abnormalities necessitating
pacemaker implantation
 Except for a history of smoking, no other risk
factors for atherosclerotic disease were
demonstrated.
 A strong association between calcification and
mediastinal radio- therapy was presumed when
irradiation was the sole risk factor in the
absence of other risk factors for valvular disease
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 Discussion
• several factors implicated irradiation as the cause of the
severe calcification of the ascending aorta, coronary
artery, and aortic valve:
1. calcification of the ascending aorta was more severe on
the anterior wall than on the posterior wall.
2. severe calcification was seen in the segment from the
ascending aorta to the proximal arch whereas no
calcification was apparent in the descending and the
abdominal aorta.
3. Heavy calcification was distributed only in the irradiated
region
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 Conclusion
• In conclusion, it appears that severe
calcification of the aortic valve and aorta and
accelerated atherosclerotic heart diseases
can be interpreted as later complications of
prior irradiation.

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