[A case report of coronary artery bypass grafting in a patient with ankylosing spondylitis]

Area of Science:

• Cardiology
• Rheumatology
• Surgical Innovation

Background:

• Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine, with cardiac involvement being a rare but serious complication.
• Unstable angina pectoris, a critical manifestation of coronary artery disease (CAD), requires timely and effective intervention.
• The coexistence of AS and significant CAD presents unique perioperative challenges.

Observation:

• A 67-year-old male patient presented with symptoms of anginal pain.
• Coronary angiography revealed severe stenoses in multiple coronary artery segments, including 90% in segment 6, 90% in segment 11, proximal 75% and distal 90% in segment 3, 99% in 4 PD, and 99% with delay in 4 AV.
• The patient had a history of ankylosing spondylitis.

Findings:

• The patient successfully underwent coronary artery bypass grafting (CABG).
• Surgical reconstruction involved anastomosing the left internal thoracic artery to segment 7 and using saphenous vein grafts (SVG) for sequential bypass to PL-2, PL-1, and segment 4 PD.
• The postoperative course was uneventful, indicating successful management of both cardiac and potential AS-related perioperative risks.

Implications:

• This case demonstrates the feasibility and success of CABG in patients with coexisting ankylosing spondylitis and severe coronary artery disease.
• It underscores the importance of careful preoperative assessment and tailored surgical strategies for managing complex cardiovascular conditions in patients with rare systemic diseases.
• Further research into perioperative management protocols for such patients is warranted, particularly in regions where this comorbidity is infrequently encountered, such as Japan.