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Coronary artery bypass grafting for a patient with Tangier disease
Hiroshi Takami1, Tohru Kobayashi, Tsutomu Nakagawa
1Department of Cardiovascular Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-1-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan.
Insights
This study presents a rare case of Tangier disease with severe coronary artery disease. A staged surgical approach successfully treated the patient, relieving angina symptoms.
Area of Science:
- Cardiology
- Genetics
- Metabolic Disorders
Background:
- Tangier disease is a rare genetic disorder characterized by extremely low high-density lipoprotein (HDL) levels.
- Severe coronary artery disease (CAD) in conjunction with Tangier disease presents unique therapeutic challenges.
- Juvenile arteriosclerosis is often associated with Tangier disease, necessitating early intervention.
Observation:
- A 56-year-old male with Tangier disease presented with angina pectoris due to triple-vessel CAD.
- Extremely low HDL (1 mg/dl) confirmed the diagnosis of Tangier disease.
- Calcified ascending aorta precluded conventional coronary artery bypass grafting.
Findings:
- Initial treatment involved minimally invasive coronary artery bypass (CAB) for the left anterior descending artery and percutaneous transluminal coronary angioplasty for other lesions.
- Recurrent angina occurred due to refractory restenosis of the left circumflex artery lesion.
- A second CAB procedure, utilizing a free right internal thoracic artery graft, successfully revascularized the obtuse marginal and posterolateral arteries.
Implications:
- This case highlights the successful management of complex coronary artery disease in a patient with Tangier disease.
- Staged surgical interventions, including minimally invasive techniques and arterial grafting, can be effective in managing refractory symptoms.
- Aggressive lipid management and cardiovascular monitoring are crucial for patients with Tangier disease and associated arteriosclerosis.
Abstract:
A 56-year-old man with Tangier disease suffering from angina pectoris due to triple-vessel coronary artery disease evidenced extremely low blood high-density lipoprotein of 1 mg/dl, a specific laboratory indicator of this rare genetic disorder of lipid metabolism, considered to accompany juvenile arteriosclerosis. Because of the calcified ascending aorta, we conducted combined minimally invasive coronary artery bypass (CAB) for the left anterior descending coronary artery and percutaneous transluminal coronary angioplasty for other coronary artery lesions initially instead of conventional coronary artery bypass grafting. Angina recurred, however, due to refractory restenosis of the left circumflex coronary artery lesion. Two years later, we redid the CAB, grafting the free right internal thoracic artery from the functional left internal thoracic artery sequentially onto obtuse marginal and posterolateral coronary arteries. The patient returned to work angina-free.