Perioperative Management and Surgical Approaches in a Rare Case of Coronary Artery Bypass Grafting Surgery in a Patient with Takayasu’s Arteritis with Acute Atypical Presentation: A Case Report
Takayasu’s arteritis (TA) is an idiopathic vasculitis that mainly affects the aorta and its proximal branches. The female-to-male ratio is 8:1. The mean age at the time of diagnosis is 29 years. It has a higher incidence in Southeast Asia, South Africa, and Latin America. Histological changes show that granulomatous inflammation initially involves the vasa vasorum of the truncal aorta, affecting the adventitia and media and resulting in pan arteritis. Clinical manifestations of this disease are singular or in combination of cerebrovascular disease, ocular disorders, “pulseless disease,” atypical coarctation, renovascular hypertension, aneurysm formation, and pulmonary involvement. In approximately 10% of cases of TA, there is coronary involvement, with the left ostia being most commonly affected. Surgical treatment is challenging as the mammary arteries are frequently affected by inflammation, which may render them unsuitable as a graft. Therefore, saphenous venous grafts (SVGs) are mostly used in these coronary artery bypass grafting (CABG) surgeries. But severely inflamed lesions of the aorta make the proximal venous anastomosis to the aorta rather dangerous. This may lead to increased postoperative complications such as hemorrhage and early graft failure. We report a case of a 23-year-old male patient with TA with 90% occlusion of the left and right main coronary artery ostia (left main coronary artery [LMCA] and right coronary artery [RCA]) who was successfully treated by off-pump CABG using a bovine pericardial patch on the aorta for the proximal anastomosis. The patch prevents contact between the inflamed tissue and the graft, which is believed to reduce the risk of graft failure. The patient also had acute dilatation of the aortic root, which did not require any surgical repair.
