Ümit HALICI, Serdar MENEKŞE, Hüseyin AĞIRBAŞ

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

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 subklavian arterin osteal tıkalı olduğu ve subklaviyan steal sendromu olduğu izlenmiştir. Operasyonda 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

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

Initially characterised by involvement of the aorta and its main branches, eye disorders, and weakening of the upper extremity pulses, Takayasu arteritis is a vascular disease with unknown etiology. There are several surgical options for its treatment. A 54-yearold man with Takayasu arteritis presented in our clinic with unstable coronary artery disease. The patient underwent operation with a diagnosis of ischemic mitral regurgitation. Turunkus brakiosefalikus and left subclavian 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 bypass with a dacron graft. Then we simultaneously performed aortic-coronary bypass and mitral valve surgery. Prior to the operation, we initiated a steroid therapy, which continued postoperatively. We did not observe any complications. In order to maintain cerebral perfusion, we believe that open heart surgery and vascular procedures can be simultaneously and safely applied in patients with Takayasu arteritis who are in their remission process

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Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rattern M. Takayasu arteritis. Ann Intern Med 1994;120:919-29.
Numano F: Differences in clinical presentation and outcome in different countries for Takayasu's arteritis. Curr Opin Rheumatol 1997;9:12-5.
Takayasu M: A case with unusual changes of the central vessels in the retina. Acta Soc Ophtalmol Jpn 1908;12:554-5.
Shimizu K,Sano K, Pulseless disease. Rinsho Geka (Clinical Surgery) 1948;3: 377-96.
Frövig AG, Löken AC: Syndrome of obliteration of the arterial branches of the aortic arch due to arteritis. Act. Psychiatr Neurol Scard 1931;26;313-37.
Lupi-Herrera E; Sanches-Torres G, Marcusharmer J. Mispirets J, Horwitz S, Vela JE. Takayasu arteritis: Clinical study of 107 cases. Am Heart J 1977;93:94-103.
Report of commitee on study of arteritis. Japan Ministry of Education: Clinical and pathological studies of aortitis syndrome. Jpn Heart J 1968;9;76-87.
Chugh KS, Sahuja V. Takayasu's arteritis as a cause of renovascular hypertension in Asian countries. Am J Nephrol 1992;12:1-8.
Inokochi K, Yagl H, Nakamura M, Torii S, A case of pulseless disease and angina pectoris. Kokyu To Junican 1961;9;447-50.
Amano J, Suzuki A: Coronary artery involvement in Takayasu's arteritis. J Thorac Cardiovasc Surg 1991;102:554-60.
Orea Tejada A, Sanchez Torres G, Kuri Alfaro J. Cardiac damage in Takayasu's arteritis. Study in 125 patients. Arch Inst Cardiol Mex 1983;53:441-7.
Siburian G, Hashimato Y, Numano F. Ventricular arythmias in Takayasu arteritis. Int J Cardiol 1993;40:243-9.
Lupi-Herrera E, Sanchez-Torres G, Marchushamer J, Mispireta J. Takayasu's arteritis. Clinical study of 107 cases. Am Heart J 1997;93:94-103.
Thomas D, Dobourg O, Biletry O, Kieffer E, Vedel J, Fenoll L, et al: [Coronary involvement in Takayasu's disease. Apropos of 3 cases, of which 2 were surgically treated, and review of the literature]. Arch MalCoear 1984;77:386-96.
Ohara K, Kasewaga T, Ando T,Kawazoe K, Kosakai Y, Kaku K, et al: Surgical treatment for coronary artery disease associated with aortitis syndrome, Kyobu Geka 1986;39:423-8.
Saito Y, Hirota K, Ito I, Yamaguchi H, Takeda T. Clinical and pathological studies of five autopsied cases of aortitis syndrome. Jpn. Heart J 1972;13:107-17,.
Mark A, Creager MD. Takayasu arteritis. Rev Cardiovasc Med. 2001;2:211-4.