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[A case of coronary artery bypass grafting in a patient with active systemic lupus erythematosus]
S Higashi1, H Mitake, T Nagahama
1Department of Cardiovascular Surgery, Shizuoka Red Cross Hospital, Japan.
Insights
Systemic lupus erythematosus (SLE) patients undergoing open heart surgery require vigilant infection prevention. Active SLE poses significant risks, including post-operative pulmonary infection, necessitating specialized care.
Area of Science:
- Cardiology
- Rheumatology
- Infectious Disease
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organ systems.
- Cardiac involvement in SLE can range from pericarditis to coronary artery disease.
- Myocardial ischemia in SLE patients can be exacerbated by inflammation and autoimmune processes.
Observation:
- A 59-year-old female presented with chest pain due to severe left coronary artery obstruction.
- Hematology and renal biopsy confirmed active systemic lupus erythematosus (SLE).
- Coronary artery bypass grafting (CABG) was performed due to worsening cardiac function from myocardial ischemia.
Findings:
- The patient developed a pulmonary infection approximately two months after CABG.
- Despite initial satisfactory recovery, the patient succumbed to complications three months post-surgery.
- Active SLE significantly increased the risk of post-operative complications, particularly infection.
Implications:
- Open heart surgery in active SLE patients demands stringent infection prevention and management protocols.
- Multidisciplinary care involving cardiology, rheumatology, and infectious disease specialists is crucial.
- Early recognition and aggressive treatment of infections are vital for improving outcomes in SLE patients undergoing cardiac surgery.
Abstract:
A 59-year-old female was admitted to our hospital because of chest pain. Coronary angiography revealed severe obstruction of the left coronary artery. The findings of hematology and renal biopsy were interpreted as showing active systemic lupus erythematosus (SLE). Coronary artery bypass grafting was performed before steroid therapy because of worsening cardiac function due to myocardial ischemia. Postoperative course had been satisfactory immediately after operation, but the patient showed pulmonary infection about two months after operation and died three months after surgery. In open heart surgery for a patient with active SLE, special care must be taken to the prevention and treatment for infection.