Articles

Dilated Cardiomyopathy and Severe Functional Valvular Regurgitation in a Young Adult with Prior Childhood Chemotherapy: Progressive Ventricular Dysfunction Despite Surgical Correction and Optimal Medical Therapy

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Background: Late cardiotoxicity is a recognized complication in survivors of childhood cancer treated with potentially cardiotoxic agents, particularly anthracyclines. These therapies may cause progressive myocardial injury through mechanisms involving oxidative stress, mitochondrial dysfunction, and cardiomyocyte apoptosis. Over time, this process can lead to ventricular remodeling, dilated cardiomyopathy, and heart failure. Advanced ventricular dilation frequently results in functional mitral and tricuspid regurgitation, further worsening hemodynamic burden and clinical outcomes.

Case summary: We report the case of a 42-year-old man with a history of non-Hodgkin lymphoma diagnosed in childhood and treated with chemotherapy, without subsequent cardiologic follow-up. From the age of 29, he developed progressive heart failure symptoms. Transthoracic echocardiography revealed severe functional mitral regurgitation with mixed mechanism (Carpentier type I due to annular dilation and type IIIa due to leaflet restriction) and massive tricuspid regurgitation, associated with severe atrial dilation, grade III diastolic dysfunction, and pulmonary hypertension. Left ventricular systolic dysfunction was documented with an ejection fraction of 36% and markedly reduced global longitudinal strain (−11%), consistent with non-ischemic dilated cardiomyopathy.

The patient underwent mitral valve replacement and tricuspid valve repair but developed intraoperative cardiac arrest and postoperative mixed shock. Persistent severe ventricular dysfunction (LVEF 26%, GLS −8%) and multiple complications were observed.

Conclusion: This case highlights the importance of long-term cardiovascular surveillance in childhood cancer survivors and the role of strain imaging in detecting chemotherapy-related cardiomyopathy.

Dilated Cardiomyopathy Following Total Thyroidectomy Complicated by Severe Mitral Regurgitation: A Case Report and Literature Review

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Cardiac dysfunction following thyroid and parathyroid surgery is rare but clinically significant. Hormonal disturbances, including iatrogenic hypothyroidism and calcium metabolism disorders, may adversely affect myocardial function and the mitral valve.

We report the case of a 56-year-old woman who underwent thyroidectomy and parathyroidectomy in 2024. One year later, after discontinuation of thyroid hormone replacement and calcium supplementation, she progressively developed dyspnea, peripheral edema, and heart failure. Transthoracic echocardiography revealed hypokinetic dilated cardiomyopathy (left ventricular ejection fraction [LVEF] 32%) associated with severe functional mitral regurgitation. Laboratory tests showed marked hypothyroidism (TSH 95 µIU/mL, free T4 2.39 pmol/L), hypocalcemia (total calcium 43 mg/L), and elevated NT-proBNP levels (7,850 ng/L).

Management combined guideline-directed medical therapy for heart failure, gradual thyroid hormone replacement, calcium supplementation, and discussion of potential surgical/valvular intervention. After six months of follow-up, a significant improvement in cardiac function and regression of mitral regurgitation were observed.

This case highlights the importance of cardiologic and endocrinologic surveillance after thyroid and parathyroid surgery. Early recognition of hormonal abnormalities and cardiac dysfunction is crucial to optimize management and improve prognosis.