Takayasu arteritis with multiple cardiovascular complications
Takayasu arteritis with multiple cardiovascular complications
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DOI：
10.1007/s003800170005
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发表时间：
2001-12-01
影响因子：
1.5
通讯作者：
Toyama, J
中科院分区：
文献类型：
--
作者：
Nishiyama, A;Matsubara, S;Toyama, J
一位60岁的日本妇女于1990年首次出现心力心绞痛。她接受了冠状动脉造影，并被诊断为双侧冠状动脉口狭窄和高须动脉炎。尝试行多血管冠状动脉旁路移植术（CABG），但双侧胸内动脉和胃大脑膜动脉供动脉血流不足，升主动脉壁钙化严重，无法吻合隐静脉移植物。因此，通过静脉移植将肝固有动脉与左前降支连接。2000年4月，患者心绞痛加重。双侧锁骨下动脉闭塞，双侧冠状动脉口狭窄及移植物静脉闭塞，主动脉瓣返流，2例重度降主动脉狭窄。主动脉瓣置换术、冠状动脉和主动脉血运重建术是可取的，但严重的主动脉壁钙化和增厚使这些干预措施无法实现。选择药物治疗。病人出院时无严重心绞痛。这些严重的心血管并发症的合并，不允许任何手术干预是非常罕见的。
A 60-year-old Japanese woman first presented in 1990 with effort angina. She underwent coronary angiography and was diagnosed with bilateral coronary ostial stenosis and Takayasu arteritis. Coronary artery bypass graft surgery (CABG) for multiple vessels was attempted, but the blood flow in the bilateral internal thoracic and gastroepiploic arteries was to poor for a donor artery, and the calcification of the ascending aortic wall was too severe for anastomosis of saphenous vein grafts. Therefore, the proper hepatic artery was connected to the left anterior descending artery using a vein graft. In April 2000, the patient's angina worsened. Occlusions of both subclavian arteries, bilateral coronary ostial stenosis and vein graft occlusion, aortic valve regurgitation, and two severe stenoses of the descending aorta were observed. Aortic valve replacement, and coronary and aorta revascularization were desirable, but the severe aortic wall calcification and thickening rendered these interventions impossible. Treatment with medication was chosen. The patient was discharged without severe angina. A combination of these serious cardiovascular complications which do not allow any surgical intervention is very rare.