Coronary artery involvement in Takayasu's arteritis. Collective review and guideline for surgical treatment

Abstract

Coronary artery disease is a rare involvement of Takayasu's arteritis. From 1961 to 1989, 63 patients, including our five, have been reported to undergo operations for coronary artery disease resulting from Takayasu's arteritis. Most of the patients were Japanese (86%) and female (86%). The initial clinical manifestation was angina pectoris in 71%. Among 92 lesions, coronary ostia were most frequently involved (73%) followed by nonostial proximal lesions (18.5%). Forty-two of 62 (67.7%) ostial lesions of the left main coronary artery had more than 90%, or complete, stenosis. Aortic regurgitation was associated in 28 patients (44.4%). Myocardial revascularization was performed in 49, and transaortic endarterectomy in 12. Concomitant aortic valve replacement was done in 16 patients. Operative mortality was five (7.9%), and late deaths were reported in three patients. Postoperative steroid therapy was performed in 22. Operation was repeated in two patients because of graft failure. Thus coronary artery disease resulting from Takayasu's arteritis should be suspected in young Asian women with angina pectoris. The timing preferred for surgical intervention is during an inactive phase. Two procedures are commonly chosen for surgical intervention, either transaortic endarterectomy or coronary revascularization with vein grafts. Postoperative steroid therapy is strongly recommended to those patients who are operated on in the clinically or histologically active stage.