Article Text

Download PDFPDF
Radiation-induced dystrophic calcification and severe valvular stenosis: the central role of multimodality 3D cardiac imaging in disease assessment and planning of combined transcatheter aortic and mitral valve replacement
  1. Kashan Ali,
  2. Douglas James Lee,
  3. Dawn L Adamson and
  4. Jamal Nasir Khan
  1. Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, Coventry, UK
  1. Correspondence to Dr Kashan Ali; drkashanali{at}


Cardiac disease after mediastinal radiotherapy can result in progressive valvular thickening and dystrophic calcification with ensuing leaflet restriction and dysfunction. This can ultimately manifest as valvular stenosis and/or regurgitation. We report a case of a 61-year-old woman with symptomatic severe aortic stenosis and severe mitral stenosis due to severe dystrophic calcification postmediastinal radiotherapy for lymphoma. She was deemed surgically inoperable due to dense, continuous calcification throughout the leaflets and annuli of both valves, aortomitral continuity, proximal coronary arteries and proximal porcelain aorta. She underwent simultaneous transcatheter aortic valve replacement and transcatheter mitral valve replacement with an excellent technical and clinical result at 7-month follow-up. We also describe the central role of multimodality three-dimensional transoesophageal echocardiography and multidetector cardiac CT imaging in assessing the severity of valve disease, characterising the nature of cardiac calcification and guiding decisions on surgical operability and transcatheter intervention.

  • interventional cardiology
  • valvar diseases
  • radiology (diagnostics)
  • radiotherapy
  • surgical diagnostic tests

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors KA was involved in the collecting of information for the case, the initial writing of the draft of the case, and researching existing data on radiation-induced valvular disease and combined TAVR and TMVR. DJL was involved in reviewing and editing drafts of the report. DLA was the main physician involved in the clinical care of this patient. JNK performed TOE and CT scan, retrieved the images/videos for the case from PACS and also oversaw the conduction of the project.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.