Ümit Halıcı, Serdar Menekşe, Hüseyin Ağırbaş

Takayasu Arteritli Bir Hastada Koroner Bypass ve Mitral Kapak Replasmanıyla Eş Zamanlı Uygulanan Aorta-Bisubklavian Bypass Operasyonu: Olgu Sunumu

Takayasu arteriti, temelde aorta ve büyük dallarını tutan göz bozuklukları ve üst ekstremite nabızında belirgin zayıflamayla karakterize etiyolojisi bilinmeyen bir damar hastalığıdır. Bu hastalıkta cerrahi tedavi seçenekleri farklı özelliklere göre şekillenebilmektedir. 54 yaşında Takayasu arteriti olan erkek hasta kliniğimizde unstable koroner arter hastalığı ve iskemik mitral yetmezliği tanılarıyla opere edilmiştir. Hastada turunkus brakiyosefalikus ve sol sub-klavian arterin osteal tıkalı olduğu ve subklaviyan steal sendromu olduğu izlenmiştir. Ope-rasyonda güvenli bir cerrahi için serebral perfüzyonun devamı açısından öncelikle dacron greftle asendan aorta bisubklavian bypass yapılmıştır. Sonrasında eş zamanlı olarak aortakoroner bypass ve mitral valve operasyonu gerçekleştirilmiştir. Operasyon öncesi remisyonda olan hastaya steroid tedavisi başlanmış ve operasyon sonrası da devam edilmiştir. Hastada herhangi bir komplikasyon izlenmemiştir. Remisyon dönemindeki Takayasu arteritli olgularda serebral perfüzyonun devamı açısından açık kalp cerrahisiyle eş zamanlı vasküler prosedürlerin güvenle uygulanabileceğini düşünüyoruz.

Aortic Bypass Surgery Simultaneously Performed with Coronary Artery Bypass Grafting and Mitral Valve Replacement in a Patient with Takayasu Arteritis: A Case Report

Initially characterised by involvement of the aorta and its main branches, eye disorders, andweakening of the upper extremity pulses, Takayasu’s arteritis is a vascular disease with unknownetiology. There are several surgical options for its treatment. A 54-year-old male with Takayasu’sarteritis was presented in our clinic with unstable coronary artery disease. The patient underwentoperation with a diagnosis of ischemic mitral regurgitation. Turunkus brakiosefalikus and leftsubclavian artery osteal were occluded and we also observed signs of subclavian steal syndrome.For a safe surgery and to maintain cerebral perfusion we first performed ascending aorta bypasswith a dacron graft. Then we simultaneously performed aortic-coronary bypass and mitral valvesurgery. Prior to the operation, we initiated a steroid therapy, which continued post-operatively.We did not observe any complications. In order to maintain cerebral perfusion, we believe thatopen heart surgery and vascular procedures can be simultaneously and safely applied in patientswith Takayasu arteritis who are in their remission period.

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