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[Aortocoronary bypass graft in coronary arterial stenosis with aortitis syndrome]
Insights
Aortitis syndrome can cause rare coronary artery "skip lesions," leading to unstable angina. Successful bypass surgery relieved symptoms in a patient with this uncommon condition.
Area of Science:
- Cardiovascular Medicine
- Rheumatology
- Vascular Surgery
Background:
- Aortitis syndrome, an inflammatory condition affecting the aorta, can lead to coronary artery stenosis.
- Coronary artery involvement in aortitis typically affects the ostia and proximal segments.
- Coronary artery 'skip lesions' in aortitis are considered uncommon and rarely reported.
Observation:
- A 50-year-old female with aortitis syndrome presented with unstable angina due to severe coronary arterial narrowings.
- Coronary arteriogram revealed 95% occlusion in the left anterior descending and left circumflex arteries (skip lesions), a rare manifestation of aortitis syndrome.
- Collateral vessels visualized the distal circumflex artery, enabling targeted surgical intervention.
Findings:
- A single aortocoronary bypass graft to the left anterior descending artery was successfully performed.
- The patient experienced complete resolution of anginal chest pain postoperatively.
Implications:
- This case underscores the uncommon presentation of coronary artery "skip lesions" in aortitis syndrome.
- Successful surgical management demonstrates the feasibility of treating such rare coronary manifestations.
- Highlights the importance of comprehensive vascular assessment in patients with aortitis syndrome.
Abstract:
A 50-year old female who had aortitis syndrome with unstable angina due to severe coronary arterial narrowings is described. On the preoperative coronary arteriogram, 95% occlusion of the left anterior descending coronary artery (segment 6) and the left circumflex artery (segment 11), so-called "skip lesion" of aortitis syndrome, were revealed. The distal circumflex artery was well visualized through collateral vessels of the posterior descending branch of the right coronary artery. Therefore single aortocoronary bypass graft to the left anterior descending branch was done with good success. Postoperatively the patient has been completely free from anginal chest pain. Narrowing of the coronary artery due to aortitis syndrome is considered uncommon. Stenotic lesions have been reported to be limited mostly to the ostia and proximal segments of the coronary arteries, connecting to the aortic wall. Moreover, so-called "skip lesion" of the coronary artery as seen in this case is thought to be very rare.