Bilateral coronary ostial disease following mediastinal irradiation: a case report

INTRODUCTION: Ostial coronary artery disease is rare with a reported incidence of 0.07 to 0.25% in all patients undergoing angiography. It has a strong association with previous mediastinal irradiation, which induces specific histological changes distinct from atherosclerotic lesions. The radiation also affects the myocardium and surrounding structures, which can alter the surgical approach. CASE PRESENTATION: We present a case of a 62-year-old female who developed bilateral ostial coronary artery stenosis 32 years following therapeutic radiotherapy for Hodgkin’s disease. She underwent successful coronary artery bypass surgery using a combination of arterial and venous conduits. Postoperatively she developed a clinical picture of diastolic impairment not detected pre-operatively. She was managed appropriately and made a successful recovery. CONCLUSIONS: This case highlights the cardiac pathology associated with mediastinal irradiation, which should be suspected during surgical assessment, especially in long-term survivors. It heightens the surgeon’s awareness so a more thorough evaluation of coronary anatomy, ventricular function and potential conduits is made prior to surgery.