Noyan Temuçin OĞUŞ, Murat BAŞARAN, Eylül KAFALI, Özer SELİMOĞLU

Full arterial revascularization with “no-touch” technique in a patient with familial homozygous hypercholesterolemia

Ailesel homozigot hiperkolesterolemi oldukça nadir bir patoloji olmasına karşın ciddi kalp hastalıkları ile birlikte bulunabilir. Bu patoloji yüksek kolesterol plazma düzeyleri ve aterosklerozun hızlanmasına bağlı olarak ciltte ksantoma tarzı lezyonlar, erken koroner arter hastalığı ve aterosklerotik aort oluşmasına neden olmaktadır. Bu hastalara erken yaşta koroner arter bypass greftleme ameliyatları gerekebilmektedir. Bu yazıda çıkan aortta ciddi ateroskleroz nedeniyle “no-touch” yöntemi ile başarılı bir koroner arter bypass greftleme ameliyatı yapılan ailesel homozigot hiperkolesterolemili 22 yaşında kadın hasta sunuldu. “No-touch” tekniği ile yapılan full arteryel revaskülarizasyon sistemik embolizasyon riskini önlenmekte ve uzun dönem greft açıklığı sağlamaktadır.

Ailesel homozigot hiperkolesterolemili bir hastada “no-touch” teknikle yapılan full arteryel revaskülarizasyon

Although familial homozygous hypercholesterolemia is a very rare pathology, it may be associated with severe cardiac disease. It causes high plasma levels of cholesterol with accelerated atherosclerosis resulting in the development of cutaneous xanthomas, premature coronary artery disease and aortic atherosclerosis. These patients may require early coronary artery bypass grafting operation. In this article, we describe a 22-year-old female patient with familial homozygous hypercholesterolemia who was treated successfully with a “no-touch” technique coronary artery bypass grafting operation because of severely atherosclerotic ascending aorta. The use of full arterial revascularization by using a “no-touch” technique prevents the risk of systemic embolization and also offers good long-term patency.

PDF

___

1) Kawasuji M, Sakakibara N, Fujii S, Yasuda T, Watanabe Y. Coronary artery bypass surgery with arterial grafts in familial hypercholesterolemia. J Thorac Cardiovasc Surg 2000;119:1008-13.
2) Mabuchi H, Koizumi J, Shimizu M, Takeda R. Development of coronary heart disease in familial hypercholesterolemia. Circulation 1989;79:225-32.
3) Suma H. Coronary artery bypass grafting in patients with calcified ascending aorta: aortic no-touch technique. Ann Thorac Surg 1989;48:728-30.
4) Buffolo E, de Andrade CS, Branco JN, Teles CA, Aguiar LF, Gomes WJ. Coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg 1996;61:63-6.
5) Takahashi T, Nakano S, Shimazaki Y, Kaneko M, Hirata N, Nakamura T, et al. Long-term appraisal of coronary bypass operations in familial hypercholesterolemia. Ann Thorac Surg 1993;56:499-505.
6) Acar C, Ramshey A, Pagny JY, Beyssen B, Fabiani JN, Deloche A, et al. Five year results of coronary bypass grafting using the radial artery. 77th Annual Meeting of the American Association for Thoracic Surgery, May 6, 1997. Washington, DC; 1997. p. 100-1.
7) Demirkiliç U, Bolcal C, Küçükarslan N, Bingöl H, Oz BS, Kuralay E, et al. Middle and late-term results of coronary artery bypass graft surgery in very young (20-29 years) patients. [Article in Turkish] Anadolu Kardiyol Derg 2004;4:25-9.
8) Prapas SN, Anagnostopoulos CE, Kotsis VN, Stavropoulos GP, Sidiropoulos AV, Ananiadou OG, et al. A new pattern for using both thoracic arteries to revascularize the entire heart: the pi-graft. Ann Thorac Surg 2002;73:1990-2.
9) Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, et al. Influence of the internal-mammaryartery graft on 10-year survival and other cardiac events. N Engl J Med 1986 2;314:1-6.