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[Aortitis syndrome with aortic regurgitation and bilateral coronary ostial stenosis]
1Division of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan.
Insights
Aortitis syndrome in a young male led to severe aortic regurgitation and coronary artery disease. Surgical intervention included aortic valve replacement and coronary artery bypass grafting using internal thoracic artery and gastroepiploic artery.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Vascular Surgery
Background:
- Aortitis syndrome can present with severe cardiovascular complications, including aortic regurgitation and coronary artery ostial stenosis.
- Early diagnosis and aggressive management are crucial for patients with aortitis syndrome and associated cardiac conditions.
Observation:
- A 17-year-old male presented with chest oppression and syncope, indicative of acute cardiovascular compromise.
- Aortography revealed severe aortic regurgitation with annular dilatation; coronary angiography showed significant left coronary ostium stenosis and right coronary ostium occlusion.
Findings:
- Despite initial steroid therapy, symptoms persisted, necessitating urgent aortic valve replacement with a prosthetic valve and coronary artery bypass grafting.
- The coronary reconstruction utilized the internal thoracic artery (IHA) and gastroepiploic artery (GEA), a novel approach for this condition.
- Postoperative recovery was uneventful, with angiography confirming graft patency and absence of perivalvular leakage.
Implications:
- This case highlights the successful application of combined aortic valve replacement and coronary artery bypass grafting in managing acute cardiovascular complications of aortitis syndrome.
- The use of IHA and GEA for coronary reconstruction in this context represents a potentially valuable surgical strategy.
- Further research is warranted to evaluate the long-term outcomes of this reconstructive approach in similar patient populations.
Abstract:
A 17-old-male was admitted to our hospital with the chief complaints of anterior chest oppression and syncope. His aortography showed severe aortic regurgitation with annular dilatation, and his coronary angiography revealed 90% stenosis of the left coronary ostium and total occlusion of the right coronary ostium. Because his symptoms increased in spite of steroid therapy during 2 weeks, aortic valve replacement with 25 mm SJM prosthetic valve and coronary artery bypass grafting using internal thoracic artery (IHA) and gastroepiploic artery (GEA) were performed at acute stage. Postoperative course was almost uneventful. Postoperative angiography showed graft patency and no evidence of perivalvular leakage. This is, to the best of our knowledge, the first report of coronary reconstruction using IHA and GEA for coronary disease associated with aortitis syndrome.