[Takayashu's disease and double coronary artery involvement treated by bypass]

The author reviews the reported clinical, angiographic and pathological features of Takayashu's disease with coronary lesions with respect to one personal case. Coronary extension of this inflammatory panaortitis presents with effort or resting angina or complications which worsen the prognosis (infarction, arrhythmias, cardiac failure). Histologically, the ostial or truncal lesions correspond to hyperplasia of the three arterial layers, infiltrated with inflammatory cells, oedema, disorganisation of connective tissue, fibrinoid necrosis and fibrosis. The main coronary lesions are best visualised by selective coronary angiography which demonstrates the proximal position of the stenotic or aneurysmal lesions, always associated with a good distal coronary tree. The treatment is essentially surgical by aorto coronary bypass either with a saphenous vein graft or the internal mammary artery. The five reported cases, including the present one, have not been followed up for a long enough period to assess the value of this technically difficult surgery. The results seem to be good in 3 out of the 5 cases. However, the follow up is too short to speak of significant experience in this field, the longest postoperative period being only 3 years.