# Radiation-Induced Valvular Heart Disease: A Narrative Review of Epidemiology, Diagnosis and Management

## TL;DR

Radiation therapy for cancer can cause heart valve disease years later, requiring careful management and new treatment approaches.

## Contribution

This review highlights the epidemiology, diagnosis, and evolving management strategies for radiation-induced valvular heart disease.

## Key findings

- Radiation-induced valvular heart disease typically affects left-sided valves after a latency of 10–20 years.
- Transcatheter approaches offer new treatment options for high-risk patients with radiation-induced heart valve disease.
- Structured long-term surveillance is essential for early detection of radiation-associated valvular heart disease in cancer survivors.

## Abstract

Mediastinal radiotherapy plays a central role in the treatment of several malignancies, particularly Hodgkin lymphoma and breast cancer. However, exposure to thoracic radiation is associated with long-term cardiovascular complications, among which valvular heart disease (VHD) is increasingly recognized. Radiation-induced VHD typically presents after a latency period of 10–20 years and is characterized by progressive valve fibrosis, thickening, and calcification, most commonly affecting the left-sided valves. Management of radiation-induced VHD generally follows standard guidelines but remains challenging due to extensive calcification and coexisting radiation-related cardiac or pulmonary injury. A history of thoracic radiotherapy is associated with increased perioperative risk and may negatively impact surgical outcomes, which often alters the risk–benefit balance and favors less invasive therapeutic approaches. Advances in the transcatheter approach have expanded treatment options for this high-risk population; however, data on long-term outcomes remain limited. Evolving dose-reduction techniques, such as deep-inspiration breath-hold, intensity-modulated radiotherapy, and proton therapy, together with predictive dosimetric models, aim to minimize future cardiac toxicity. Given the delayed onset and progressive nature of radiation-associated VHD, structured long-term surveillance is essential to enable early detection and timely intervention in cancer survivors at risk.