{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T15:36:59Z","timestamp":1766158619052,"version":"3.44.0"},"reference-count":7,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,12,2]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2020-239368","type":"journal-article","created":{"date-parts":[[2020,12,28]],"date-time":"2020-12-28T12:24:51Z","timestamp":1609158291000},"page":"e239368","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["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"],"prefix":"10.1136","volume":"13","author":[{"given":"Kashan","family":"Ali","sequence":"first","affiliation":[{"name":"Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas James","family":"Lee","sequence":"additional","affiliation":[{"name":"Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dawn L","family":"Adamson","sequence":"additional","affiliation":[{"name":"Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamal Nasir","family":"Khan","sequence":"additional","affiliation":[{"name":"Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,12,28]]},"reference":[{"key":"2025082701473173000_13.12.e239368.1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-308765"},{"key":"2025082701473173000_13.12.e239368.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2018.04.028"},{"key":"2025082701473173000_13.12.e239368.3","doi-asserted-by":"crossref","first-page":"724","DOI":"10.21037\/acs.2018.10.06","article-title":"Complexities of transcatheter mitral valve replacement (TMVR) and why it is not transcatheter aortic valve replacement (TAVR)","volume":"7","author":"Wyler von Ballmoos","year":"2018","journal-title":"Ann Cardiothorac Surg"},{"key":"2025082701473173000_13.12.e239368.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2018.01.269"},{"key":"2025082701473173000_13.12.e239368.5","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehn285"},{"key":"2025082701473173000_13.12.e239368.6","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.4244\/EIJV12I9A195","article-title":"First case of transcatheter native mitral and aortic valve replacement","volume":"12","author":"Weich","year":"2016","journal-title":"EuroIntervention"},{"key":"2025082701473173000_13.12.e239368.7","first-page":"988","article-title":"Simultaneous transcatheter transfemoral aortic and transeptal mitral valve replacement using Edward SAPIEN S3","volume":"92","author":"Fanari","year":"2018","journal-title":"Catheter Cardiovasc Interv"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-239368","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T08:47:40Z","timestamp":1756284460000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-239368"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12]]},"references-count":7,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12,28]]},"published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1136\/bcr-2020-239368"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-239368","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2020,12]]}}}