Denyan MANSUROĞLU, Ulusoy Nilgün BOZBUĞA, Kaan KIRALİ, Hasan ARDAL, Hakan AKKAYA, Alper ONBAŞILI, Vedat ERENTUĞ, Esat AKINCI, Cevat YAKUT, Hasan Basri ERDOĞAN

Erişkin yaş koroner arter çıkış anomalilerinde ateroskleroz ve cerrahi tedavi

Amaç: Koroner çıkış anomalilerinde ateroskleroz tanısı komplet koroner revaskülarizasyon kararında önemli rol oynar. Bu çalışmada, koroner çıkış anomalisi bulunan 12 olgunun klinik tablo, aterosklerozun lokalizasyonu ve derecesi ile cerrahi yaklaşımlarla ilgili deneyimimizi gözden geçirilmiştir. Materyal ve Metod: Koroner çıkış anomalisi ile aterosklerotik koroner arter hastalığı bulunan 9 olguya koroner arter bypass greftleme (KABG) ameliyatı yapılmıştır. Bir olguya koroner arterleri anjiyografik olarak aterosklerotik olmamasına karşın anjina pektorisin tedavisi için KABG uygulanmıştır. Çıkış anomalisi olan, fakat aterosklerotik lezyon saptanmayan 2 olguda ise bu koroner arterlere KABG gerekmemiştir. Bulgular: Oniki olguda erken mortalite görülmedi. Koroner revaskülarizasyon uygulanan olguların hiçbirinde perioperatif miyokard enfarktüsü görülmedi. Bir hasta postoperatif 28. günde mediastinite bağlı sepsis tablosu ile kaybedildi. Sonuç: Koroner arter çıkış anomalileri ile ateroskleroz arasındaki ilişki özellikle KABG yapılması planlanan genç hasta grubunda göz önünde bulundurulmalıdır. Bu grup hastalar mortalite ve morbidite risk artışı olmaksızın cerrahi olarak tedavi edilebilmektedir.

Atherosclerosis in coronary artery anomalies and surgical treatment in adults

Background: Coronary artery origin anomalies associated with atherosclerosis have an important role in the decision on complete cononary artery revascularization. The purpose of this study was to review our clinical experience on 12 cases with coronary anomalies, clinical presentation, location and degree of atherosclerosis, and surgical approaches. Methods: Nine cases with coronary origin anomaly underwent coronary artery bypass grafting (CABG) associated with atherosclerotic coronary artery disease. Coronary bypass was performed in 1 case for relief of anjina pectoris even his coronary arteries were found angiographically free of atherosclerosis. Two cases of anomalous coronary artery without atherosclerotic lesions did not require CABG. Results: There was no early mortality in the series. Perioperative myocardial infarction was not recorded in any of the patients underwent coronary revascularization. One case died from sepsis due to mediastinitis at 28th postoperative day. Conclusions: The relationship between coronary artery origin anomaly and atherosclerosis has to be considered especially in young CABG candidate patients. This group of patients can be operated without overwhelming mortality and morbidity risks.

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