Coronary Ostial Stenosis in Takayasu's Arteritis

doi:10.1378/chest.78.2.330

Chest

Volume 78, Issue 2, August 1980, Pages 330-331

https://doi.org/10.1378/chest.78.2.330 Get rights and content

A patient with Takayasu's arteritis with left coronary ostial narrowing is presented. The dramatic clinical and pathologic findings are discussed in detail. Emphasis is placed on making the diagnosis as soon as possible, in order to expedite bypass surgery to prolong life.

Section snippets

CASE REPORT

The patient was a 45-year-old woman who in December 1976 noted discoloration of her left hand, with increased sensation to touch and cold. She had a positive lupus erythematosus preparation and an antinuclear antibody titer of 1:40; however, her rheumatoid arthritis factor, level of complement, hemolytic complement, VDRL test, and doublestranded DNA binding were normal.

An arteriogram demonstrated thrombosis of the left subclavian artery, with retrograde thrombosis into the left vertebral

DISCUSSION

Takayasu's arteritis of the coronary arteries has been reported;1, 2, 3 however, symptoms of coronary involvement are rarely the initial presentation. More commonly, systemic complaints such as headaches, fever, and heart failure precede angina. Angina pectoris was the presenting symptom in only four of 16 patients described in the literature.¹ Two of the four patients underwent successful bypass surgery.¹ Our patient's ostial lesion was amenable to grafting, but prior to surgery, she died,

REFERENCES (4)

PR Cipriano et al.
Coronary arterial narrowing in Takayasu’s aortitis
Am J Cardiol
(1977)
E Lupi-Herrera et al.
Takayasu’s arteritis: clinical study of 107 cases
Am Heart J
(1977)

There are more references available in the full text version of this article.

Cited by (33)

Chronic Periaortitis of Ascending Aorta With Bilateral Ostial Coronary Stenosis in a Young Female
2017, Annals of Thoracic Surgery
An 18-year-old woman without any risk factors for coronary artery disease or systemic vasculitis and infection presented with recurrent angina at rest. Coronary angiography revealed 100% occlusion of the ostial left main coronary artery and severe ostial right coronary artery stenosis. She underwent successful coronary artery bypass graft surgery. At surgery, the external surface of the ascending aorta was covered with a soft-tissue thickened mass; histopathology of the mass revealed chronic nonspecific inflammatory aortitis.
Isolated fibromuscular dysplasia of the coronary ostium: a rare cause of sudden death. Case report and review of the literature
2015, Cardiovascular Pathology
Citation Excerpt :
Isolated or solitary coronary ostial stenosis has been defined as a localized narrowing of the coronary ostium, greater than 50%, with no evidence of obstructive distal vessel disease or any other coronary artery or aortic disease [47]. Common causes include atherosclerosis [47], aortic valve disease [49], cardiovascular syphilis [50], Takayasu’s aortitis [51], and as a complication of heart surgery [52]. Isolated coronary ostial stenosis secondary to FMD is rare [42,47].
We present a unique case of sudden death in a 21-year-old man with history of cocaine use and a solitary fibromuscular dysplastic lesion completely occluding the left coronary artery ostium. We document intimal proliferation of myofibroblasts at the opening of the left coronary ostium without other concomitant lesions. This report discusses the gross and histologic features of the lesion, explores in careful detail the possible etiologies, and gives a comprehensive literature review of isolated coronary ostial fibromuscular dysplasia presenting with sudden death.
2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease
2010, Journal of the American College of Cardiology
Citation Excerpt :
While patients with Type A dissection or annuloaortic ectasia may be protected from atherosclerosis (383), patients with Takayasu arteritis may occasionally have inflammatory coronary involvement with coronary aneurysms (less than 10%) (384,385). Similarly, an occasional patient with GCA may have coronary artery involvement (386,387). If ascending aortic surgery is being considered, with or without aortic valve surgery, then identification of the coronary anatomy and any underlying CAD is important for planning the best operation.
Left main coronary artery patch angioplasty: Midterm experience and follow-up with spiral computed tomography
1998, Annals of Thoracic Surgery
Background. Patch angioplasty is an alternative surgical technique in cases of left main coronary artery stenosis. We report our experience with this technique, with particular mention of the use of spiral computed tomography for the follow-up of our patients.
Methods. In this retrospective study we analyzed the results obtained in all 7 patients (3 women and 4 men) who were operated on with this technique in our institution between July 1992 and August 1994. Five consenting patients also underwent graft patency assessment with spiral computed tomographic imaging.
Results. The operation was uneventful in all patients and there were no hospital deaths. Two patients required reoperation (1 of them dying at reoperation), 1 because of restenosis of the graft and 1 because of the presence of a new stenosis in the proximal anterior descending coronary artery. The remaining 5 patients were asymptomatic after 51 ± 2 months. Spiral computed tomographic images were artifacted and of poor quality.
Conclusions. Patch angioplasty of the left main coronary artery can be a valuable therapeutic method in selected cases. Conventional spiral computed tomography is not an optimal noninvasive method for the assessment of graft patency.
Isolated left main coronary ostial stenosis in oriental people: Operative, histopathologic and clinical findings in six patients
1993, Journal of the American College of Cardiology
Objectives. This study was performed to determine whether there are differences in the operative, histopathologic, angiographic and clinical findings of isolated ostial stenosis between Oriental and western patients.
Background. Angiographic, clinical and histologic findings in isolated ostial stenosis have been reported in western but not in Oriental patients.
Methods. Six patients, all women (0.88% of a total of 684 patients who underwent coronary angiography between March 1989 and July 1991), were found to have isolated left main coronary ostial stenosis. We performed surgical ostial angioplasty with the autologous pericardial or saphenous venous patch and biopsy at the aortic arteriotomy site in four of the six patients.
Results. All six patients presented with severe angina (angina class III or IV) of short duration (mean ± SD 6.2 ± 6.2 months) and had a very low incidence of risk factors, although histopathologic examination showed typical atherosclerosis in four of the six patients. They were young to middle-aged women (mean 45 ± 3 years) except for Patient 6 (62 years). Exercise duration was short and ST segment depression, accompanied by typical angina, was observed in many leads in the warm-up period or stage I. Despite the crucial location of the lesion, most patients had well preserved left ventricular function and normal wall motion. There was no angiographically definable collateral circulation from either ipsilateral or contralateral vessels except for grade I collateral circulation in Patient 5, Operative findings demonstrated mostly yellow atheroma in the aortic wall and left cornary ostium. Coronary angiography showed only ostial stenosis of the left coronary artery in all six patients, but operative findings documented atheromatous change in the left main coronary artery in two of the six.
Conclusions. The clinical, angiographic, histopathologic and operative findings of Oriental patients were similar to those reported in western patients, but the incidence of isolated left main coronary ostial stenosis was higher in the Oriental group. Angiographically definable isolated coronary ostial stenosis may often not be true isolated ostial stenosis.
Left main coronary trunk compression by dilated main pulmonary artery in atrial septal defect: Report of three cases
1992, Journal of Thoracic and Cardiovascular Surgery
Narrowing of the left main coronary trunk, which was compressed by the dilated pulmonary artery, was associated with atrial septal defect in three adults. One of them had severe pulmonary hypertension. Coronary angiograms revealed localized narrowing of the left main coronary trunk, and the left main coronary trunk had a concave shape. No stenosis of other coronary arteries was observed. In all patients the atrial septal defect was closed with a polytetrafluoroethylene patch. In the patient with 75% narrowing of the left main coronary trunk, aorta-coronary bypass was performed; it was not performed in the two with 50% narrowing. In two survivors postoperative coronary angiograms showed that the narrowing of the left main coronary trunk improved or disappeared. These results suggest that markedly dilated pulmonary arteries easily compress the left main coronary trunk and cause narrowing, which improves after atrial septal defect closure. (J Thorac Cardiovasc Surg 1992;104:449-52)

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: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

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Selected ReportsCoronary Ostial Stenosis in Takayasu's Arteritis

Section snippets

CASE REPORT

DISCUSSION

Am J Cardiol

Am Heart J

Selected Reports
Coronary Ostial Stenosis in Takayasu's Arteritis