Taguchi Takura, Nishi Hiroyuki, Kitahara Mutsunori, Shirasaki Yukie, Yoshitatsu Masao
Department of Cardiovascular Surgery, National Hospital Organization, Osaka National Hospital, Osaka, JPN.
Cureus. 2024 May 11;16(5):e60115. doi: 10.7759/cureus.60115. eCollection 2024 May.
Coronary artery aneurysms (CAAs) due to an immunoglobulin G4 (IgG4)-related disease (IgG4-RD) are relatively rare, and there is no consensus on the choice of treatment method. In the present study, we report the results of the surgical treatment for multiple giant CAAs caused by IgG4-RD. A 71-year-old man was diagnosed with severe aortic regurgitation and CAAs. A blood test showed high IgG4 levels, and computed tomography revealed four giant coronary artery aneurysms: two in the right coronary artery (RCA) (proximal RCA and posterior descending artery (PDA)), one in the left anterior descending (LAD), and one in the diagonal branch (Dx). We planned aortic valve replacement, coronary aneurysm resection, and coronary artery bypass grafting (CABG). After finishing aortic valve replacement, the CAAs in proximal RCA, LAD, and Dx were resected. The proximal and distal tracts of the aneurysm were closed with a pericardial bovine patch and ligation. However, since the distal PDA was too calcified to be anastomosed, and the PDA aneurysm was smaller than the others, it was decided to leave the PDA aneurysm. The anastomoses of SVG-RCA and Dx, as well as the left internal thoracic artery to LAD, were performed. Histopathological examination of the aneurysm wall showed a high IgG4-positive cell/IgG-positive cell ratio, and a diagnosis of IgG4-RD was made. In the treatment of CAAs due to IgG4-RD, it is essential to select a procedure that takes into account the size, location, and nature of the aneurysm, and comorbidities. To ensure resection of the aneurysm and blockade of blood flow, closure of the inflow and outflow tracts with a pericardial bovine patch and CABG are effective.
由免疫球蛋白G4（IgG4）相关疾病（IgG4-RD）引起的冠状动脉瘤（CAA）相对罕见，对于治疗方法的选择尚无共识。在本研究中，我们报告了IgG4-RD所致多发性巨大CAA的外科治疗结果。一名71岁男性被诊断为严重主动脉瓣反流和CAA。血液检查显示IgG4水平升高，计算机断层扫描显示四个巨大冠状动脉瘤：两个位于右冠状动脉（RCA）（RCA近端和后降支动脉（PDA）），一个位于左前降支（LAD），一个位于对角支（Dx）。我们计划进行主动脉瓣置换、冠状动脉瘤切除和冠状动脉旁路移植术（CABG）。完成主动脉瓣置换后，切除了RCA近端、LAD和Dx的CAA。动脉瘤的近端和远端用牛心包补片封闭并结扎。然而，由于远端PDA钙化严重无法吻合，且PDA动脉瘤比其他动脉瘤小，决定保留PDA动脉瘤。进行了SVG-RCA和Dx以及左胸廓内动脉至LAD的吻合。动脉瘤壁的组织病理学检查显示IgG4阳性细胞/IgG阳性细胞比例高，诊断为IgG4-RD。在治疗IgG4-RD所致的CAA时，必须选择一种考虑到动脉瘤的大小、位置、性质和合并症的手术方法。为确保切除动脉瘤并阻断血流，用牛心包补片封闭流入和流出道以及CABG是有效的。
