Coronary artery bypass surgery for patients with left main coronary lesions due to Takayasu's arteritis

Abstract

Two patients with documented Takayasu's arteritis and severe left main coronary lesion were operated on. The first patient was a 17-year-old boy operated with a double saphenous vein coronary artery bypass graft in 1982, the patient survived 12 years but died suddenly due to associated aortic insufficiency. The second case was a 46-year-old female patient who was successfully operated on.

Anaortic Off-pump Coronary Artery Bypass Grafting in Patients with Takayasu's Arteritis

“…A recent meta-analysis demonstrated that avoiding aortic manipulation during CABG decreased the rate of perioperative stroke [13]. For myocardial revascularization, a saphenous vein graft has commonly been used with a method of direct anastomosis to the ascending aorta because the subclavian arteries, from which the ITA originate, are commonly affected vessels in TA [3-5,7]. In addition, ITAs have rarely been used for in situ grafting because the arterial grafts can be influenced by the underlying TA itself and graft occlusion may occur later.…”

Angina and Coronary Ostial Lesions in a Young Woman as a Presentation of Takayasu's Arteritis

“…O~onary artery involvement occurs in only 9-15% of patients [3][4][5][6][7]. Most of the coronary artery lesions are thoUght to be secondary to an extension of the aortitis [8,9] and are predominantly limited to the ostia or the proximal portion of the coronary arteries [4,9]. Further exten-Sl~~of the aortitis may include the aortic valve leaflets, W ich leads to aortic regurgitation as in this case.…”

“…\Vhen the disease is no longer active in a patient with persisting cardiac ischemic symptoms angioplasry can be employed with good palliative results but significant coronary stenosis in multiple vessels m[ay be best managed by coronary artery bypass surgery 4]. Arterial grafts, especially internal mammary grafts, rough preferred for usual coronary revascularizati on, are es~frequently of use [4] and less than an ideal choice in Patients with Takayasu's arteritis. This is secondary to the prOcliVity to occlusion or stenosis of the subclavian or nnominate artery that is proximal to the take-off of the Internal mammary artery, which could lead to subclavian and coronary steal as in our patient.…”

“…If the patient requires urgent cardiac revascularizati on S~rgery prior to treating the active phase of the disease, Igh dose corticosteroid therapy is warranted in the perloperative period [4]. In addition, these patients need prolonged postoperative surveillance, as stenosis or occlusioñ the grafts may occur with progression of the disease in e coronary arteries, aorta and aortic branches [4].…”

“…If the patient requires urgent cardiac revascularizati on S~rgery prior to treating the active phase of the disease, Igh dose corticosteroid therapy is warranted in the perloperative period [4]. In addition, these patients need prolonged postoperative surveillance, as stenosis or occlusioñ the grafts may occur with progression of the disease in e coronary arteries, aorta and aortic branches [4]. With disease progression, even mild stenosis of the subclavian artery proximal to the take-off of the internal ammary artery can decrease the blood flow through this ypass conduit to the heart, and this flow can further be decreased with exercise of the arms.…”