Noma M, Sugihara M, Kikuchi Y
Department of Internal Medicine, Kyushu Kosei-Nenkin Hospital, Japan.
Angiology. 1993 Oct;44(10):839-44. doi: 10.1177/000331979304401013.
This report describes a rare clinical course of a young Japanese woman with Takayasu's arteritis and a review of the literature. Her first symptom was angina pectoris due to isolated left coronary ostial stenosis, which was relieved by aortocoronary bypass grafting surgery using a saphenous vein graft. At that time, the C-reactive protein was negative and the histopathologic findings of the specimens of the aorta could not confirm aortitis. Although she was free from any cardiovascular symptoms for about fifteen years, syncopal attacks occurred owing to severe stenosis of the major branches of the aortic arch revealed by intravenous digital subtraction arteriograms. Thus, Takayasu's arteritis could be a cause of coronary ostial stenosis in young women even if the inflammatory findings are negative and the major branches of the aortic arch are not involved at operation. In addition, revascularization using internal thoracic arteries might possess a potential risk of coronary insufficiency due to a later involvement of these proximal arteries.
本报告描述了一名患有高安动脉炎的年轻日本女性罕见的临床病程，并对相关文献进行了综述。她的首发症状是由于孤立性左冠状动脉口狭窄导致的心绞痛，通过使用大隐静脉移植物进行主动脉冠状动脉搭桥手术得以缓解。当时，C反应蛋白为阴性，主动脉标本的组织病理学检查结果无法证实主动脉炎。尽管她在大约十五年的时间里没有任何心血管症状，但静脉数字减影血管造影显示主动脉弓主要分支严重狭窄，导致了晕厥发作。因此，即使炎症表现为阴性且手术时主动脉弓主要分支未受累，高安动脉炎仍可能是年轻女性冠状动脉口狭窄的原因。此外，由于这些近端动脉后期受累，使用胸廓内动脉进行血运重建可能存在冠状动脉供血不足的潜在风险。
