Bilateral Coronary Ostial Stenosis Associated with Aortitis Syndrome

Oginö, Kazuhíde; Tokuyasu, Yoshiki; Motorniya, Takeshi; Sugiura, Masahiro; Endo, Masahiro

doi:10.1378/chest.99.5.1286

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…Ostial lesions conventionally have been treated with myocardial revascularization techniques 4,6,7 , including either the left or the right internal thoracic artery or both of these, or their combination with saphenous vein grafting. This surgical option can be inconvenient because of coronary trunk occlusion, competitive flow, the coronary steal phenomenon, retrograde perfusion over an extensive myocardial area and the requirement for future surgical interventions, especially in young patients.…”

Section: Discussionmentioning

confidence: 99%

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Coronary bilateral ostial enlargement using the saphenous vein in a patient with syphilitic aortitis

Croti¹,

Gregori²,

Marcial³

et al. 2000

Arq. Bras. Cardiol.

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Syphilis has been succesfully controlled in recent years; involvement of the heart and the aorta have become relatively rare events. The incidence and degree of seriousness of syphilitic aortitis is greater in the initial portion of the ascending aorta involving the coronary ostia and the valvulae of the aortic valve. Heggtveit 1 , in a clinicopathological review of syphilitic aortitis, noted uni or bilateral coronary ostial stenosis with aortic regurgitation in 14% of patients.Several surgical tactics for the correction of coronary ostial stenosis have been reported: endarterectomy 2-5 , aorto-coronary bridging with either arterial 6,7 or venous 4 grafts or both , and ostial reconstruction via the anterior 3,8 or posterior 8,9 approaches.We have performed surgical treatment of a patient presenting with bilateral coronary lesions and aortic regurgitation by ostial amplification via the anterior approach. Along with the aortic valve substitution, we used grafting with autogenous saphenous vein to reconstruct both coronary ostia. Case ReportA forty-eight-year old male Caucasian patient related a history of two months of intense nonirradiating precordial pain unrelated to effort, dyspnea, throbbing and decreased visual accuity. In his past medical history, he reported several episodes of veneral disease but denied the existence of familial heart disease.Upon examination, the patient was in good physical condition, eupneic, with arterial blood pressure of 16/40mm-Hg in the right upper limb and 70/40mmHg in the left upper limb; his left radial and arm pulses were of lower amplitude relative to the right, which showed strong pounding feature. The first heart sound was normal, the second was of decreased intensity, with a protomesodiastolic regurgitative murmur ++/++++ in aortic and accessory aortic areas.The thoracic radiograph revealed aortic ectasia and a normal cardiac area. The electrocardiogram showed a sinusal rhythm, QRS axis AT + 30 o , T wave negative at 4V, flattened at V5 and V6, Dl and the VL with left ventricular hypertrophy. Dopplerechocardiography showed diffuse hypokinesia of the left ventricle and moderate aortic regurgitation with ectasia of the ascending aorta. A cinecoronariographic study showed 70% obstruction of the left coronary ostium, 60% of the right coronary ostium, serious aortic regurgitation and a critical lesion in the left subclavian artery that was treated by percutaneous transluminal coronary angioplasty at the time of diagnosis. Results of routine laboratory tests were normal with the exception of the Venereal Disease Research Laboratory test (VDRL), reactive at 1:64 dilution and positive fluorescent treponemal antibody-absorption test (FTA-ABS).The surgical approach was performed by medial sternotomy, aortic and right atrial cannulation, and extracorporeal circulation under moderate hypothermia at 30 o C. Myocardial protection was afforded by St. Thomas crystalloid solution.The aorta was transversally incised in its anterior wall, a pronounced inflammatory condition being observed. ...

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Section: Discussionmentioning

confidence: 99%

“…Several surgical tactics for the correction of coronary ostial stenosis have been reported: endarterectomy [2][3][4][5] , aorto-coronary bridging with either arterial 6,7 or venous 4 grafts or both , and ostial reconstruction via the anterior 3, 8 or posterior 8,9 approaches.…”

mentioning

confidence: 99%

Coronary bilateral ostial enlargement using the saphenous vein in a patient with syphilitic aortitis

Croti¹,

Gregori²,

Marcial³

et al. 2000

Arq. Bras. Cardiol.

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“…After 2 years, stenosis of the ITA graft, RCA, and axillary artery occurred which was successfully treated by angioplasty. Ogino et al [86] also reported a case with bilateral coronary ostial stenosis treated by bilateral ITAs. Postoperative coronary angiography revealed distal right ITA stenosis which was treated by angioplasty.…”

Section: Coronary Artery Involvementmentioning

confidence: 96%

“…Postoperative coronary angiography revealed distal right ITA stenosis which was treated by angioplasty. It is important to remember that later frequent involvement of the subclavian artery or abdominal aorta and its branches might happen in Takayasu arteritis [12,86,87]. In addition to coronary artery surgery, concomitant AVR was employed in more than 25 cases [10, 11, 14, 42, 53-55, 77, 80, 84, 89-91], Bentall's operation or a modification in 5 cases [11,84,92], mitral annuloplasty in 1 case [14], and extra-anatomical bypass in 1 case [93].…”

Section: Coronary Artery Involvementmentioning

confidence: 99%

Surgical treatment of cardiac involvement in Takayasu arteritis

Amano

Suzuki

1992

Heart Vessels

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Cardiac involvement is a serious disorder in Takayasu arteritis. Surgical treatment of aortic root and coronary artery lesions due to Takayasu arteritis has many potential difficulties due to its inflammatory nature. We operated on 15 patients with cardiac involvement stemming from Takayasu arteritis. These patients are classified into 3 groups depending on the clinical diagnosis and surgical procedures employed: coronary artery involvement alone--coronary artery bypass grafting (CABG), three patients (group A), aortic regurgitation with intact coronary artery--Aortic valve replacement or modified Bentall's operation, eight patients (group B), and aortic regurgitation with coronary artery involvement g aortic valve replacement or modified Bentall's operation with CABG, (4 patients) (group C). CABG was performed using saphenous vein graft. For aortic valve replacement or replacement of both the aortic valve and ascending aorta, a prosthetic valve or composite graft with Teflon felt flange was fabricated during surgery and treated with fibrin glue before insertion. A double fixation method with reinforcement by a Teflon felt strip was employed for proximal anastomosis of the flanged prosthesis. A button-shaped coronary ostium was directly anastomosed to the composite graft. There was no operative or hospital mortality. One patient died of brain abscess at 6 months after surgery and another patient with CABG required a second operation due to graft failure. Steroid therapy is recommended in cases diagnosed as being in an active stage until the inflammatory signs disappear.

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