Tratamento cirúrgico sem circulação extracorpórea de arteriopatia relacionada com arterite de Takayasu envolvendo aorta e vasos da base

Abstract

We report the cases of 2 female patients with Takayasu's arteritis referred to our service with lesions affecting the descending thoracic aorta and great vessels. One of the patients had a critical obstructive lesion in the left coronary ostium. Both patients underwent surgery without extracorporeal circulation, with full heparinization and autotransfusion.Takayasu's arteritis is a chronic vasculitis of unknown etiology, whose first case report dates back to 1908 1 . Women account for 80 to 90% of the cases, and the ages of the affected patients range from 10 and 40 years 2,3 . Takayasu's arteritis affects initially the aorta and its primary 4 . The inflammation may be restricted to the thoracic or abdominal aorta, or both, and its, and, sometimes, the manifestations are related to impairment of the coronary ostia. As the disease progresses, all great vessels are commonly affected, and the impairment may range from local lesions to extensive segmentary stenoses. The abdominal aorta and pulmonary arteries are involved in approximately 50% of the patients. The degree of activity of the inflammatory process varies with time, with apparent exacerbations and reductions or remissions.The indication for surgical treatment is often related to severe circulatory complications, such as refractory hypertension and decompensated heart failure, in addition to signs of myocardial ischemia in cases with lesions involving the coronary ostia.The surgical technique varies from case to case, because the number of vessels affected and the extent of the impairment vary, which requires the use of all surgical resources developed for cardiac surgery. Case ReportCase 1 -A 32-year-old white female, who sought our service due to arterial hypertension of difficult control, headache, and claudication of the left lower limb. The patient reported that she began to experience intense headache approximately 8 months before, being then referred to the cardiologist, who diagnosed severe hypertension. Clinical treatment was initiated, and the symptoms improved slightly. Forty-five days before admission, she reported pain in the lower limbs, mainly in the left side, triggered by physical activity, which evolved to pain at rest. On admission, the physical examination revealed arterial hypertension and a significant decrease in the pulses in the lower limbs. Transthoracic echocardiography showed a significant myocardial hypertrophy. Thoracoabdominal tomography showed extensive segmentary stenosis of the descending aorta, with a critical point (95%) at the level of the thoracoabdominal transition ( fig. 1). The patient underwent angiography of the ascending aorta, aortic arch, and descending and abdominal aorta. Not only were the tomographic findings confirmed, but a critical obstructive lesion was detected in the celiac trunk, as was an extensive segmentary lesion in the left carotid artery. Neither the pulmonary artery, nor its branches had any lesion.The tests of inflammatory activity were within the normal range. Only VHS was slightly altered. On...

Doença de Takayasu com grave envolvimento cardíaco e arterial em pré-escolar

“…Angiography is the imaging method of choice 5,10 , traditionally used to evaluate the affected vessels, but it is a procedure of high risk due to exposure to radiation, rupture of vessels, hemorrhages, and infections. It was not indicated in this case because of the presence of giant aneurysms at sites of vascular access for the exam.…”