Syphilitic aortitis causing bilateral coronary ostial stenosis

Coronary ostial stenosis in otherwise normal coronary vessels is a rare complication of syphilitic aortitis. A 47-year-old man with no coronary risk factors developed severe isolated ostial stenosis in the left main coronary artery and right coronary artery. He underwent coronary artery bypass grafting using the bilateral internal thoracic arteries and gastroepiploic artery and recovered uneventfully.     

An aorto-coronary bypass graft operation of left coronary ostial stenosis due to aortitis syndrome

A 24-year-old female with unstable angina due to aortitis syndrome was reported. The coronary-arteriogram in hospital showed 75 percent stenosis of the left coronary ostium. Following two months' steroid therapy for active inflammation, aortocoronary bypass graft was implanted. After the operation. This patient became free from angina attack. Steroid therapy was continued postoperatively as well. The coronary-arteriogram taken seven months after the operation, revealed the patency of the graft.     

A case report of aortitis syndrome with massive aortic regurgitation (AR), and ostial stenosis of the right coronary artery

A 55-year-old female with massive aortic regurgitation and ostial stenosis of the right coronary artery due to aortitis syndrome was reported. The patient was admitted to the hospital with anterior chest pain and dyspnea on exertion. Retrograde aortogram showed massive aortic regurgitation and selective coronary angiogram revealed ostial stenosis of the right coronary artery. She was treated with aorto-coronary bypass (A-C bypass) and aortic valve replacement (AVR) with St. Jude Medical prosthetic valve. At operation, ostial stenosis of the right coronary artery due to aortitis syndrome was confirmed. Aortic valve replacement with a prosthetic valve and saphenous vein grafting to the distal right coronary artery were performed. Steroid therapy was started immediately after the operation. She recovered well and no complications was recognized after the operation.     

Axilloaxillary bypass for the treatment of subclavian artery stenosis complicated by bilateral common carotid artery occlusion: technical case report

OBJECTIVE AND IMPORTANCE: We successfully treated a patient with stenosis of the left subclavian artery, complicated by bilateral common carotid artery occlusion, via axilloaxillary bypass surgery. CLINICAL PRESENTATION: A 67-year-old patient with a history of hypertension and cerebral infarction underwent neck irradiation for treatment of a vocal cord tumor. Three months later, he began to experience transient tetraparesis several times per day. The blood pressure measurements for his right and left arms were different. Supratentorial blood flow was markedly low. The common carotid arteries were bilaterally occluded, and the right vertebral artery was hypoplastic. Therefore, only the left vertebral artery contributed to the patient's cerebral circulation; his left subclavian artery was severely stenotic. INTERVENTION: The patient underwent axilloaxillary bypass surgery because the procedure avoids thoracotomy or sternotomy, manipulation of the carotid artery, and interruption of the vertebral artery blood flow. The patient has been free of symptoms for more than 5 years. CONCLUSION: Neurosurgeons should be aware that extra-anatomic bypass surgery is an effective treatment option for selected patients with cerebral ischemia.     

Aortocoronary bypass graft in coronary arterial stenosis with aortitis syndrome

A 50-year old female who had aortitis syndrome with unstable angina due to severe coronary arterial narrowings is described. On the preoperative coronary arteriogram, 95% occlusion of the left anterior descending coronary artery (segment 6) and the left circumflex artery (segment 11), so-called "skip lesion" of aortitis syndrome, were revealed. The distal circumflex artery was well visualized through collateral vessels of the posterior descending branch of the right coronary artery. Therefore single aortocoronary bypass graft to the left anterior descending branch was done with good success. Postoperatively the patient has been completely free from anginal chest pain. Narrowing of the coronary artery due to aortitis syndrome is considered uncommon. Stenotic lesions have been reported to be limited mostly to the ostia and proximal segments of the coronary arteries, connecting to the aortic wall. Moreover, so-called "skip lesion" of the coronary artery as seen in this case is thought to be very rare.     

Aortitis syndrome with aortic regurgitation and bilateral coronary ostial stenosis

A 17-old-male was admitted to our hospital with the chief complaints of anterior chest oppression and syncope. His aortography showed severe aortic regurgitation with annular dilatation, and his coronary angiography revealed 90% stenosis of the left coronary ostium and total occlusion of the right coronary ostium. Because his symptoms increased in spite of steroid therapy during 2 weeks, aortic valve replacement with 25 mm SJM prosthetic valve and coronary artery bypass grafting using internal thoracic artery (IHA) and gastroepiploic artery (GEA) were performed at acute stage. Postoperative course was almost uneventful. Postoperative angiography showed graft patency and no evidence of perivalvular leakage. This is, to the best of our knowledge, the first report of coronary reconstruction using IHA and GEA for coronary disease associated with aortitis syndrome.     

A case of ostial stenosis with the PAS-Port proximal anastomosis system in off-pump coronary artery bypass grafting

The use of an automatic aortic connector device for proximal saphenous vein graft anastomoses eliminates the need for aortic clamping during off-pump coronary artery bypass grafting and may reduce the incidence of stroke in the elderly and in patients with severe aortic atherosclerosis. The PAS-Port proximal anastomotic system is a recently developed sutureless automatic saphenous vein graft anastomosis device. We used the system in thirteen patients. Overall handling, feasibility and safety of the device were satisfactory in our limited experience. However, one patient developed severe ostial and proximal graft stenosis in four months postoperative angiogram.     

冠状动脉硬化性心脏病合并左锁骨下动脉严重狭窄非体外循环下同期手术的临床经验

目的探讨非体外循环冠状动脉旁路移植同时主动脉-锁骨下动脉旁路治疗冠状动脉硬化性心脏病(冠心病)合并锁骨下动脉重度狭窄的手术方法及效果.方法2003年1月～2004年5月,我院治疗须行冠状动脉旁路移植术同时合并左锁骨下动脉近端重度狭窄3例,术中先行主动脉-锁骨下动脉旁路,左乳内动脉获得满意的流量后,再行非体外循环冠状动脉旁路移植.结果手术时间210～340 min,平均283 min,出血量570～1 630 ml,平均963 ml.游离左乳内动脉后量杯测流量均＜5 ml/min,主动脉-锁骨下动脉旁路后量杯测流量均＞50 ml/min,乳内动脉远端与前降支吻合后流量仪测流量12～27 ml/min,平均20 ml/min.术后临床症状缓解,未发现冠脉-锁骨下动脉窃血综合征.3例随访3～6个月,平均5个月,无心绞痛发作.结论非体外循环冠状动脉旁路移植同时主动脉-锁骨下动脉旁路手术是治疗冠心病合并锁骨下动脉重度狭窄简单而有效的方法.     

A subclavian artery aneurysm associated with aortitis syndrome.

We performed surgery on a 61-year-old woman who had increasingly severe right shoulder pain and paresthesia in her right upper extremity as a result of a large right subclavian artery aneurysm. She had suffered from aortitis syndrome for 10 years for which she was treated with steroids and had multiple arterial lesions, including bilateral subclavian artery aneurysms, abdominal aortic aneurysm and obstruction of bilateral superficial femoral arteries. The right subclavian artery aneurysm measured 4 cm in diameter and rupture appeared imminent, prompting surgical therapy. Via the supraclavicular incision approach and additional partial sternotomy, the aneurysm was excluded and the brachiocephalic to right axillar arterial bypass was set up using an extended polytetrafluoroethylene graft. The patient recovered without complications and a subclavian artery aneurysm demonstrated by computed tomography was thrombosed 1 month after surgery. In conclusion, we recommend the exclusion technique to treat subclavian artery aneurysms in cases in which aneurysmectomy is likely to injure adjacent veins and nerves.     

A case of aortitis syndrome with left coronary ostial stenosis and aortic regurgitation treated by transaortic coronary endarterectomy and aortic valve replacement

A case, 23-year-old female of aortitis syndrome with left coronary ostial stenosis and aortic regurgitation was reported. The coronary angiography showed critical stenosis of the left coronary ostium with intact main stem and its branches. The aortogram revealed aortic regurgitation of grade III, and multiple obstructive or stenotic lesions on the left common carotid artery, the origin of the left renal artery, the inferior mesenteric artery and the abdominal aorta. After improvement of inflammatory findings by steroid therapy during 2 months, transaortic coronary endarterectomy and aortic valve replacement with 21 mm Bj?rk-Shiley valve were performed successfully. Postoperative course was uneventful. Coronary angiography performed at the 57th day after the operation showed complete removal of the left coronary ostial stenosis, and aortography showed no evidence of perivalvular leakage of the aortic valve prosthesis. The indication of transaortic coronary endarterectomy and the technique used to avoid aortic valve detachment which may be caused by recurrence of aortitis were discussed in this paper.     

解剖外途径动脉转流术治疗锁骨下动脉闭塞症

为提高锁骨下动脉闭塞症的治疗效果,作者报告了１９８９年～１９９６年采用非经胸解剖外途径治疗２０例锁骨下动脉闭塞症的经验。本组男９例,女１１例。１７例有上肢缺血表现,１１例有脑部缺血症状。１７例行颈动脉－锁骨下／腋动脉转流,３例行腋动脉－腋动脉转流术。除１例大动脉炎因远端流出道差转流血管阻塞疗效不理想外,其余患者患肢及脑缺血表现均明显改善或消除。无手术死亡。作者认为采用解剖外途径治疗锁骨下动脉闭塞症,无需开胸,创伤小,操作简便安全,并发症少,通畅率高,尤其适合于手术耐受性差的患者,值得进一步推广使用。     

A case of coronary artery bypass grafting using bilateral mammary arteries in a patient with systemic lupus erythematosus

A 40-year-old female who had been treated with steroid for 10 years because of systemic lupus erythematosus (SLE) was admitted to our department for triple-vessel disease with LMT lesion. She underwent bilateral internal mammary artery grafting to the right ventricular branch of RCA and the No. 7 segment of LAD. Intraoperative free flow was 70 ml/min in both bypass grafts. She dropped to severe shock with a high fever of 40 degrees C and decreased the white blood cell count of 900/mm3 on the 6th postoperative day. These clinical and laboratory findings were suggestive of rebound phenomenon of SLE or withdrawal syndrome of steroid therapy. She was treated with pulse therapy of methyl-prednisolone and her condition improved in two weeks. Histological findings of the right internal mammary artery revealed stenotic lesion of about 50%, but on June 24, 1988, postoperative angiography showed a good patency of both internal mammary arteries. Only a few reports of successful attempt of coronary artery bypass grafting for coronary lesion due to SLE are available in the literature. Some important problems concerning the surgical treatment as well as the therapy of steroid involved in this case were discussed.     

Left coronary ostial stenosis in aortitis syndrome--patch mounted graft technique for proximal anastomosis

Late restenosis or total occlusion of proximal aortic anastomosis frequently occurs due to intimal proliferation in aortitis CABG patients although successful early postoperatively. A Gore-Tex patch (diameter 20 mm) mounted grafts to LAD and CX with a single ostium was sutured in the inflammatory aorta to prevent late occlusion in a 40-year-old female patient. Postoperative CAG a month after showed a patent graft to LAD and improved exercise treadmill test. Graft to Cx occluded due to competed flow from LAD. No aneurysm was found in the proximal anastomosis. Tissue nonpermeable Gore-Tex mounted graft is considered to be suitable for CABG in aortitis patients with the high incidence of late occlusion.     

Left coronary ostial stenosis: comparison with left main coronary artery stenosis

We compared 147 consecutive patients who had left coronary ostial stenosis with 254 consecutive patients who had left main coronary artery stenosis treated with coronary artery bypass grafting. Mean age for the left main group was 61.6 years versus 59.7 years for the left ostial group (p = not significant [NS]). In the left ostial group, 43.5% were female and in the left main group, 12% (p less than 0.005). Prior myocardial infarction had occurred in 53% of patients with left main stenosis and 36% of patients with left ostial stenosis (p less than 0.005). There were 2.45 +/- 1.00 diseased vessels in the left main group and 1.96 +/- 1.09 in the left ostial group (p less than 0.0005). Seven (3%) of the patients with left main stenosis had no associated coronary disease (greater than 50%) versus 24 (16%) of the left ostial group (p less than 0.005). The degree of left main stenosis was 90% or more in 28.3% of patients versus 42.8% with equivalent ostial narrowing (p less than 0.01). Left ventricular function was better in the left ostial group than in the left main group (1.61 +/- 0.93 versus 2.02 +/- 1.11, respectively; p less than 0.0005). One-month mortality was 10 patients (3.9%) in the left main group and 8 (5.4%) in the left ostial group (p = NS). Perioperative infarction occurred in 8.6% of patients with left main stenosis and 4.7% of patients with left ostial stenosis (p = NS). Mean follow-up was 6.1 years for the left main group and 5.4 years for the left ostial group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Angioplasty with autologous pericardium for bilateral coronary ostial stenosis in Takayasu disease

Coronary ostial stenosis is usually treated by conventional coronary artery bypass graft surgery. Although patch angioplasty is a widely accepted alternative surgical treatment, it has been reported sporadically. We encountered bilateral ostial stenosis with Takayasu disease. This report describes successful patch angioplasty using glutaraldehyde-treated autologous pericardium of bilateral coronary ostial stenosis owing to Takayasu disease.     

Transaortic patch angioplasty for left coronary ostial stenosis in a patient with Takayasu's aortitis.

A 35-year-old woman who had left coronary ostial stenosis and aortic valve regurgitation due to Takayasu's aortitis underwent transaortic patch enlargement of the stenosed left coronary ostium in combination with aortic valve replacement. This technique may be suitable and recommendable as an alternative to aortocoronary bypass grafting or endarterectomy for coronary ostial stenosis in Takayasu's aortitis.     

Re-implantation of the right coronary artery for ostial stenosis

Stenosis of the coronary arteries is rarely limited to a short ostial lesion. In such cases, consideration should be given to excising the ostial lesion and re-implanting the coronary artery. A successful case utilizing this technique is reported.     

Relation between functional coronary artery stenosis and graft occlusion after coronary artery bypass grafting

ObjectivesThis study was conducted to evaluate graft patency rates during the 5 years after coronary artery bypass grafting according to the functional significance of the coronary artery stenosis, as determined by myocardial single-photon-emission computed tomography.MethodsTwo hundred ninety-five patients who underwent coronary artery bypass grafting using Y-composite grafts based on the in situ left internal thoracic artery, and in whom preoperative stress/rest myocardial single-photon-emission computed tomography and 1-year angiographies were available were enrolled. Seven hundred sixty-nine and 262 distal anastomoses were constructed to ischemic and nonischemic areas, respectively. One-year and 5-year angiographic occlusion rates were evaluated in all and 80.3% of study patients, respectively. Factors associated with graft occlusion were evaluated using generalized linear mixed-effects models.ResultsOverall 1- and 5-year graft occlusion rates were 4.3% (44 of 1031 distal anastomoses) and 5.5% (45 out of 820), respectively. The occlusion rates of grafts bypassed to vessels with functionally significant and insignificant stenosis were 2.7% (21 out of 769) and 8.8% (23 out of 262) at 1 year and were 4.0% (25 out of 618) and 9.9% (20 out of 202) at 5 years, respectively. Graft occlusion during the 5 years after coronary artery bypass grafting was associated with the functional significance of coronary artery stenosis (odds ratio, 0.50; 95% confidence interval, 0.28-0.92). The odds ratio of the graft occlusion according to functional ischemia was lower and significant in grafts to arteries with intermediate stenosis (stenosis ≥70% but <90%; odds ratio, 0.34; 95% confidence interval, 0.13-0.93) whereas it was higher and insignificant in grafts to arteries with severe stenosis (≥90% stenosis; odds ratio, 0.76; 95% confidence interval, 0.33-1.72).ConclusionsGraft occlusion during the 5 years after coronary artery bypass grafting was associated with the functional significance of coronary artery stenosis, particularly when the stenosis degree was not severe.     

Axilloaxillary bypass for symptomatic stenosis of the subclavian artery

Since the association has been made between stenosis of the subclavian artery and neurologic symptoms, controversy has existed over the preferred surgical procedure for bypass. In addition, concern has been raised regarding the long-term patency and effectiveness of this extraanatomic procedure in relieving neurologic symptoms.Twenty-seven patients underwent this operation for posterior cerebral symptoms between 1973 and 1982; 25 were followed for up to 77 months (mean 26 months). Twenty-two patients had complete relief of symptoms, although 3 of them required a subsequent carotid endarterectomy. Two other patients had partial relief, and one patient's symptoms remained unchanged. Upper extremity symptoms, present in nine patients, were relieved by the operation. All grafts remained patent during follow-up. Axilloaxillary bypass is a durable procedure for symptomatic stenosis of the subclavian artery. It is a low-risk procedure and is therefore particularly suited for older patients with associated carotid artery disease.