Abstract
Mediastinal irradiation can potentially affect all structures within the radiation field, including the pericardium, myocardium, great vessels, valves, coronary arteries, lungs, and diaphragm. Pericardial disease is a frequent manifestation of radiation-induced heart disease (RIHD). Most patients with radiation-induced constrictive pericarditis will also have restrictive physiology as a result of radiation-induced myocardial fibrosis. Differentiating the pathophysiology associated with each clinical entity can be challenging as they often coexist and share similar clinical presentations. Multimodality imaging plays a major role in the evaluation of constrictive pericarditis and restrictive cardiomyopathy in RIHD. Determining the predominant pathology of the clinical presentation is essential, as treatment is different for each cardiac abnormality.
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26.1 Electronic supplementary material
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Parasternal long axis view demonstrating thickening of the pericardium suggested by parallel movement of the visceral and parietal pericardium, normal-sized left chambers and mitral valve thickening (AVI 32398 kb)
The shift of the ventricular septum to LV at inspiration (3rd cardiac cycle) demonstrating interventricular dependence (AVI 39334 kb)
Video 26.3
Hemodynamics of constrictive pericarditis. Left. Parasternal short axis view with prominent septal bounce. Right. Apical 4 chamber view with interventricular dependence. These changes are a result of the interrelationship of right and left ventricular pressures and filling of a heart whose free wall cannot expand because of the constrictive pericardium (PPTX 1131 kb)
Video 26.4
Echo phenotype of radiation induced restrictive cardiomyopathy. Left. Parasternal long axis view. Right. Apical 4 chamber view. Small LV cavity size with low diastolic volume and low stroke volume, frequently associated with tachycardia. LVEF is generally normal or low normal. Often coexist with other radiation induced cardiac abnormalities such as valvular disease (calcified aortic valve and mitral aortic intervalvular fibrosa) as shown (PPTX 2366 kb)
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Vitsenya, M.V., Potekhina, A.V., Liu, J.E. (2021). Cardiac Constriction and Restriction After Chest Radiotherapy for Hodgkin’s Lymphoma and Breast Cancer. In: Steingart, R.M., Liu, J.E. (eds) Atlas of Imaging in Cardio-Oncology. Springer, Cham. https://doi.org/10.1007/978-3-030-70998-3_26
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DOI: https://doi.org/10.1007/978-3-030-70998-3_26
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