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[Coronary artery bypass grafting for active aortitis syndrome with bilateral coronary ostial stenosis]
1Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan.
Insights
Coronary artery bypass grafting successfully treated a young woman with active aortitis syndrome and unstable angina. While saphenous vein and right internal thoracic artery grafts remained patent, the gastroepiploic artery graft showed limited patency due to competition.
Area of Science:
- Cardiovascular Surgery
- Inflammatory Diseases
- Vascular Grafting
Background:
- Active aortitis syndrome presents a significant challenge for surgical intervention, particularly in cases of unstable angina.
- Preoperative assessment revealed critical ostial stenosis in coronary arteries and severe inflammation of the ascending aorta.
- Standard surgical approaches may be limited in active inflammatory conditions affecting the aorta.
Observation:
- Coronary artery bypass grafting (CABG) was performed on a 31-year-old female patient.
- The ascending aorta required reconstruction with an autogenous pericardial patch for proximal anastomosis.
- Grafts included saphenous vein (SV) to the left anterior descending (LAD) artery and right internal thoracic artery (RITA) to the right coronary artery.
Findings:
- Postoperative graft angiography demonstrated adequate patency for SV and RITA grafts.
- The gastroepiploic artery (GEA) graft to the LAD showed unsatisfactory patency, likely due to competitive flow from the SV graft.
- The patient's postoperative course was otherwise satisfactory.
Implications:
- This complex CABG strategy, utilizing pericardial patch reconstruction, may be a viable option for patients with unstable angina during active aortitis.
- The findings highlight potential challenges with competitive flow in multi-arterial grafting, particularly with the GEA.
- Further research is warranted to optimize graft selection and surgical techniques in aortitis patients.
Abstract:
Coronary artery bypass grafting was performed on a 31-year-old female for treatment of active aortitis syndrome with unstable angina. Preoperative coronary angiography revealed ostial stenosis of coronary arteries. The ascending aorta was intensely inflamed. In the proximal anastomosis, the ascending aorta was sutured with an autogenous pericardial patch and anastomosed with the saphenous vein (SV) to be jointed to left anterior descending (LAD). At the same time, gastroepiploic artery (GEA) was connected to LAD by taking into account a degenerative change in remote stage. Right coronary artery was anastomosed with right internal thoracic artery (RITA). The postoperative course was satisfactory. On graft angiography SV and RITA were adequately patent, but GEA was unsatisfactorily patent because of its competition with SV for patency. This surgical procedure seemed to be an option to be indicated for a patient with unstable angina at an active inflammatory stage.