Coronary artery bypass grafting in Takayasu's disease--importance of the proximal anastomosis: a case report.
Coronary artery bypass grafting in Takayasu's disease--importance of the proximal anastomosis: a case report.
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DOI：
10.1186/s13256-015-0767-5
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发表时间：
2015-12-15
影响因子：
1
通讯作者：
Morshuis WJ
中科院分区：
文献类型：
--
作者：
Kuijer A;van Oosterhout MF;Kloppenburg GT;Morshuis WJ
治疗冠状动脉累及Takayasu动脉炎是具有挑战性的。可能需要冠状动脉旁路移植术。建议使用隐静脉移植物，因为可能有炎症累及胸内动脉。然而，将近端吻合口插入发炎的主动脉组织可能会引起狭窄。文献中只有少数病例在Takayasu动脉炎患者中插入近端吻合术。迄今为止，尚未就在Takayasu动脉炎患者中实施该手术的最佳方法达成共识。我们报告一例25岁的白人女性高松动脉炎患者，由于左主干狭窄，在两次治疗失败后复发心绞痛。她成功地接受了冠状动脉旁路移植术，使用涤纶贴片插入近端吻合口。我们首次报道了一例简单的病例，在一例患有Takayasu动脉炎的患者中，使用涤纶（Vascutek®，Renfrewshire）假体补片将近端吻合口插入炎症主动脉。贴片可以防止炎症组织与移植物接触，我们相信这可以降低移植物失败的风险。这个病例可能会启发其他胸外科医生在对炎症和脆弱的主动脉患者进行血运重建术的挑战性任务。
Treatment of coronary artery involvement in Takayasu’s arteritis is challenging. Coronary artery bypass grafting may be required. The use of saphenous vein grafts is recommended because of possible inflammatory involvement of the internal thoracic arteries. However, inserting the proximal anastomosis on inflamed aortic tissue may give rise to stenosis. Only a few cases of inserting a proximal anastomosis in patients with Takayasu’s arteritis have been reported in the literature. To date, no consensus has been reached on the best way to perform this procedure in patients with Takayasu’s arteritis. We report a case of a 25-year-old white woman with Takayasu’s arteritis who had recurrent angina after two previous treatments had failed, due to left main stem stenosis. She was successfully treated by coronary artery bypass grafting using a Dacron patch to insert the proximal anastomosis. We are the first to report an uncomplicated case in which a Dacron (Vascutek®, Renfrewshire) prosthetic patch was used to insert the proximal anastomosis on an inflamed aorta in a patient with Takayasu’s arteritis. The patch prevents contact between inflamed tissue and the graft, which we believe reduces the risk of graft failure. This case might inspire other thoracic surgeons in the challenging task of performing revascularization techniques in patients with an inflamed and fragile aorta.