Asistencia ventricular y trasplante cardíaco en las cardiopatías congénitas (original) (raw)

Cirugía Cardiovascular, 2011

Abstract

ABSTRACT Introduction Takayasu disease is a rare form of chronic non-specific large vessel vasculitis of unknown etiology. It usually affects young adults, and can be fatal in children. The first reported case is presented of ventricular assistance followed by heart transplant in a patient with Takayasu disease. Objectives The case is presented of 15 year old child who presented with chest pain and clinical signs of cardiac failure. His electrocardiogram showed ST-segment elevation in V1-V4, and he was referred for coronariography due to suspicion of acute coronary artery disease. The left main coronary artery was of small caliber and exhibited stenosis in the middle segment. The anterior descendent artery showed a thrombotic occlusion at the proximal segment, and there was a critical lesion in the circumflex branch. There was an interruption of the infrarenal abdominal aorta and common and external iliac arteries. Due to the critical situation of the patient, he was referred to urgent surgical intervention and a double bypass graft was performed without noticing any improvement in the cardiac function. A left ventricular assistance device was therefore implanted. Seventy-two hours later an orthotopic heart transplant was performed. The progress was excellent and the patient was discharged 39 days later. Histopathology studies revealed a chronic arteritis in the coronary arteries and ascending aorta, and a massive left ventricular infarction. Conclusions In a rare disease like Takayasu disease, a clear multidisciplinary and coordinated strategy is needed in order to achieve a successful therapeutic outcome.

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