Pseudoxanthoma elasticum: is the left internal mammary artery a suitable conduit for coronary artery bypass grafting?
Jim Iliopoulos1, Con Manganas, Nigel Jepson
1Department of Cardiothoracic Surgery, The Prince of Wales Hospital, The University of New South Wales, Sydney, Australia. jimiliopoulos@hotmail.com
Insights
Coronary artery revascularization is effective for coronary artery disease in pseudoxanthoma elasticum patients. However, the impact of graft harvesting and anastomosis on the left internal mammary artery requires further study.
Area of Science:
- Cardiovascular Surgery
- Medical Genetics
Background:
- Pseudoxanthoma elasticum (PXE) is a rare genetic disorder affecting elastic tissues.
- Coronary artery disease (CAD) can occur in PXE patients, necessitating revascularization.
Observation:
- Coronary artery revascularization is a viable treatment for CAD in PXE patients.
- Angiographic assessment of coronary arteries and the left internal mammary artery (LIMA) is crucial.
- A non-diseased LIMA can serve as a bypass graft.
Findings:
- The study highlights the feasibility and benefits of coronary artery revascularization in PXE.
- Careful pre-operative angiographic evaluation is essential for successful surgical planning.
- The long-term outcomes and effects of LIMA graft harvesting in PXE remain undetermined.
Implications:
- These findings underscore the importance of tailored surgical approaches for PXE patients with CAD.
- Further research is needed to understand the long-term patency and disease progression in LIMA grafts used in PXE patients.
- This study contributes to optimizing treatment strategies for this rare genetic condition.
Abstract:
Coronary artery revascularization remains a feasible and beneficial treatment for coronary artery disease in patients with pseudoxanthoma elasticum. Careful angiographic evaluation of the left internal mammary artery and coronary arteries is required in patients with pseudoxanthoma elasticum with suspected coronary artery disease. A nonstenosed left internal mammary artery at angiography may be used as a conduit for coronary artery revascularization; however, both the effect of harvest and anastomosis on the disease process in the left internal mammary artery and the long-term patency of left internal mammary artery grafts remain unknown.
