Kumar G Venkata Ramana, Agarwal N B, Javali Satish, Patwardhan Anil Madhav
P K Sen Department of Cardiovascular & Thoracic Surgery, King Edward Memorial Hospital and Seth G S Medical College, Mumbai 400012, India.
Tex Heart Inst J. 2007;34(4):470-4.
Takayasu's arteritis with coronary artery involvement is rare, and there is little published information on the subject. Coronary angiographic and histopathologic studies have revealed coronary artery lesions in 9% to 11% of cases. Coronary artery involvement consists mostly of stenosis or occlusion of the coronary ostia. We report the case of a 19-year-old woman who presented with crescendo angina. Upon investigation, we found that our patient had ostial and left main coronary arterial stenosis with left-dominant circulation; therefore, we decided that an arterial Y graft, performed on a beating heart, would provide better perfusion to the compromised myocardium than would a single graft to the left anterior descending artery. In addition, use of the Y graft obviated the need to perform a proximal anastomosis on an inflamed, edematous ascending aorta, and it conferred long-term graft patency of the internal mammary arteries. Timely coronary artery bypass grafting relieved our patient's angina, and in early follow-up she has shown good effort tolerance.
累及冠状动脉的高安动脉炎较为罕见，关于该主题的已发表信息很少。冠状动脉造影和组织病理学研究显示，9%至11%的病例存在冠状动脉病变。冠状动脉受累主要表现为冠状动脉开口狭窄或闭塞。我们报告了一名19岁女性患者，她出现进行性加重的心绞痛。经检查，我们发现该患者存在冠状动脉开口及左主干狭窄，且为左优势型循环；因此，我们认为在跳动的心脏上进行动脉Y型移植，比单纯向左前降支动脉移植能为受损心肌提供更好的灌注。此外，使用Y型移植避免了在发炎、水肿的升主动脉上进行近端吻合的需要，并且赋予了乳内动脉长期的移植通畅性。及时进行冠状动脉旁路移植术缓解了患者的心绞痛，在早期随访中，她表现出良好的运动耐量。
