Naraoka Shuichi, Uchiyama Hiroki, Yano Toshiyuki, Mikami Takuma, Harada Ryo, Kuroda Yosuke, Toda Yuki, Muranaka Atsuko, Sugawara Taro, Hasegawa Tadashi, Miura Tetsuji, Kawaharada Nobuyoshi
Department of Cardiovascular Surgery, Sapporo, Japan.
Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan.
Front Cardiovasc Med. 2021 Jun 4;8:683216. doi: 10.3389/fcvm.2021.683216. eCollection 2021.
Takayasu arteritis (TA) is a large vessel vasculitis of unknown etiology characterized by chronic inflammatory changes of the aorta and its major branches. Complications such as anastomotic aneurysm and valve detachment have been reported in active TA patients who received aortic valve replacement and graft replacement of aorta. A 61-year-old man with a history of emergency aortic valve replacement and patch closure of the noncoronary sinus of Valsalva due to acute heart failure induced by acute aortic regurgitation and ruptured sinus of Valsalva 4 years ago was referred for exertional dyspnea. Dilatation of the sinus of Valsalva together with protrusion of the right sinus of Valsalva and ostial stenosis of the left coronary artery were newly found by computed tomography (CT). A Bentall operation with concomitant coronary artery bypass grafting was successfully performed with a composite graft. Diagnosis of TA was made on the basis of histological analyses of the resected sinus of Valsalva, though other arterial manifestations were not detected by F-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography. Three months later, a follow-up study revealed left coronary ostial pseudoaneurysm at the anastomotic site together with strong F-FDG uptake, leading to commencement of steroid therapy. Eight months later, disappearance of left coronary ostial pseudoaneurysm was found by a follow-up CT scan. This is a rare TA case in whom spontaneous resolution of coronary anastomotic aneurysm by steroid therapy was found without reconstructive surgery.
高安动脉炎（TA）是一种病因不明的大血管血管炎，其特征是主动脉及其主要分支发生慢性炎症变化。据报道，在接受主动脉瓣置换和主动脉移植置换的活动性TA患者中出现了诸如吻合口动脉瘤和瓣膜脱离等并发症。一名61岁男性，有4年前因急性主动脉瓣反流和瓦氏窦破裂导致急性心力衰竭而进行急诊主动脉瓣置换和瓦氏窦非冠状动脉窦补片闭合的病史，因劳力性呼吸困难前来就诊。计算机断层扫描（CT）新发现瓦氏窦扩张，同时右瓦氏窦突出和左冠状动脉开口狭窄。采用复合移植物成功进行了带冠状动脉旁路移植术的Bentall手术。尽管通过F-氟脱氧葡萄糖（F-FDG）正电子发射断层扫描/计算机断层扫描未检测到其他动脉表现，但根据切除的瓦氏窦的组织学分析确诊为TA。三个月后，一项随访研究显示吻合部位出现左冠状动脉开口假性动脉瘤，并伴有强烈的F-FDG摄取，导致开始使用类固醇治疗。八个月后，通过随访CT扫描发现左冠状动脉开口假性动脉瘤消失。这是一例罕见的TA病例，其中通过类固醇治疗发现冠状动脉吻合口动脉瘤自发消退，无需进行重建手术。
