Takayasu's arteritis with ostial and left main coronary artery stenosis (original) (raw)
Related papers
Left main trunk ostial stenosis and aortic incompetence in Takayasu's arteritis
Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology
A 41-year-old woman with recent onset of heart failure and angina due to aortic valve incompetence and critical left coronary ostium stenosis in the setting of Takayasu's arteritis is reported. The patient was successfully surgically treated by aortic valve replacement and coronary artery bypass with saphenous vein graft, showing a cardiac event-free 17 months follow-up. Takayasu's arteritis must be included among the possible causes of coronary artery disease and aortic valve incompetence in young female patients. Although chronic inflammation of the aortic wall may result in late graft occlusion, surgical therapy is effective for short and mid-term clinical improvement.
Takayasu's Arteritis Involving the Ostia of Three Large Coronary Arteries
Korean circulation journal, 2009
Takayasu's arteritis can involve the ostia of coronary arteries. We report a patient with Takayasu's arteritis involving the ostia of three large coronary arteries who was successfully treated by percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) and had a good clinical outcome after 12 months. A 37-year-old male with unstable angina was admitted to our cardiovascular center. The patient had Takayasu's arteritis and an aortic valve replacement with a metallic valve due to severe aortic regurgitation 7 years previously. Coronary angiography (CAG) showed a 95% discrete eccentric luminal narrowing at the ostia of the large left anterior descending (LAD) and left circumflex (LCX) arteries, and a 99% discrete eccentric luminal narrowing at the ostium of the large right coronary artery (RCA). The patient was treated with prednisolone for 14 days. Two large paclitaxel-eluting stents (PES) were then implanted in the distal left main coronary artery using th...
Surgical Angioplasty For Left Coronary Ostial Stenosis in Takayasu's Disease -- A Case Report
Vascular and Endovascular Surgery, 1992
Surgical angioplasty of the left main coronary artery for severe ostial stenosis in a thirty-five-year-old oriental woman suffering from Takayasu's disease was performed by use of an onlay autologous pericardial patch through an anterior aortotomy approach. This procedure was performed to reestablish a physiologic antegrade coronary arterial flow and to avoid use of internal mammary arteries, which have little flow in Takayasu's disease, or the saphenous veins, which can also be involved in the inflammatory process. The procedure also avoids a lengthy, time-consuming triple coronary artery bypass procedure and the use of saphenous veins, which are prone to certain slow or rapid attrition. Total clinical improvement with disappearance of angina and return of the patient to NYHA functional class I with normal treadmill exercise response was immediately obtained. Angiographic restudy six months after the surgical angioplasty revealed excellent results with complete wide patency of the ostium. This represents the first report in the world literature of surgical angioplasty of a left main coronary arterial ostial stenosis in Takayasu's disease.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2006
We describe the case of a young woman with Takayasu's arteritis that initially manifested as heart failure due to left main coronary artery stenosis. The patient's occluded subclavian artery and the active inflammatory process of Takayasu's arteritis precluded coronary artery bypass grafting with the use of arterial grafts. Therefore, a drug-eluting stent was placed in the unprotected left main artery. This procedure resulted in the resolution of symptoms, with a patent stent and no new coronary lesions observed on 3-month angiography, and normal left ventricular function on 9-month echocardiography. We conclude that the use of drug-eluting stents may be an important treatment option for Takayasu's arteritis patients with life-threatening coronary artery disease for whom coronary artery bypass grafting is not an option.
Journal of Clinical Medicine
This report presents the case of a female patient diagnosed with Takayasu arteritis from childhood, with severe, refractory coronary involvement, leading to two acute coronary syndromes and multiple anginous episodes. Consequently, the patient suffered aorto-bicarotid bypass two times, multiple interventional procedures with stent implantation, balloon angioplasty, and up to ten repeated in-stent restenosis that required reinterventions, despite being on maximal immunosuppressive treatment. In recent years, various studies have been reported that aim to best characterize this particular type of vascular damage and to indicate optimal therapeutic options for treatment. The latter should be based on the activity of the underlying disease; however, no reliable markers are available in TA. The management of TA patients with coronary involvement continues to be a challenge and requires both drug and interventional techniques to avoid life-threatening events.
Management of cardiac manifestations in Takayasu arteritis
Vessel Plus, 2020
Takayasu arteritis (TA) is a chronic vasculitis involving large vessels of unknown aetiology, a disease that is more common among the Asian population and predominant in young women. Cardiac manifestations include hypertension and involvement of the cardiac valves, myocardium and coronary arteries. Surgery on these patients is always a challenge given the tissue quality and the disease activity. They are prone to long-term complications such as restenosis and graft occlusion, hence requiring lifelong surveillance. The prevalence of coronary artery disease (CAD) in TA ranges from 9 to 11%. Coronary artery bypass grafting is preferred to percutaneous coronary intervention, as the latter has a high rate of restenosis and major adverse cardiovascular events. As left subclavian artery is commonly involved, saphenous vein graft is advised as a conduit rather than internal mammary artery. Other surgical procedures described for CAD are surgical angioplasty of the left main coronary artery and transaortic coronary ostial endarterectomy. Aortic regurgitation in TA has an incidence of approximately 20%. These patients tend to have prosthetic valve detachment, paravalvular leak or pseudoaneurysm at the anastomotic site. Further repair of these valves have a high rate of failure. Considering these facts, it is advisable to do an aortic root replacement for TA patients than to consider an aortic valve replacement or David's procedure.