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Asian Cardiovasc Thorac Ann 2007;15:82
© 2007 Asia Publishing EXchange Ltd

LETTER TO EDITOR

IMPORTANCE OF OSTIAL CORONARY STENOSIS IN NON INFECTIOUS AORTITIS

Sanjay Theodore, MCh, Nainar Madhusankar, DNB, Byalal Raghvendrarao Jagannath, DNB, Kotterathu Mammen Cherian, FRACS

Department of Thoracic and Cardiovascular Surgery, Frontier Lifeline Pvt Ltd., Dr KM Cherian Heart Foundation, R-30C Ambattur Industrial Estate Road, Mogappair, Chennai 600 101, India

We read with interest the article on non infectious aortitis by Chau et al (2006;14(3):175)1. The article has several important messages that will be of immense benefit to surgeons practicing in Asia where the incidence of non infectious aortitis is relatively high.

We have encountered two such patients recently. The first patient was a 26 year old lady a known case of relapsing polychondritis, she underwent a aortic valve replacement for severe aortic regurgitation. At surgery she had normal coronary ostia, at follow up she developed severe chest pain and was diagnosed to have anterior and inferior myocardial infarction. Angiography revealed severe right and left coronary ostial stenosis, the patient expired while awaiting surgery. Steroids were not started postoperatively in this patient as the ESR was normal2.

The second patient was a seventeen year old girl with marfanoid habitus. She was diagnosed to have type A dissection with severe aortic regurgitation on the basis of CT scan and transesophageal echocardiography. At surgery we found that she had a thickened and inflamed aorta but no dissection flap was found either in the ascending or arch of aorta. The left coronary ostium was found to be pinpoint, left internal thoracic artery was taken down and anastomosed to the left anterior descending artery.

The patient made an uneventful recovery; postoperative 64 slice CT scan revealed a 50% ostial stenosis and a functioning internal thoracic artery graft.

Takayasu’s arteritis and other inflammatory aortitis are known to affect the coronary arteries, especially the left and right coronary ostia3. Proximal vein anastomosis to the aorta after CABG is prone for stenosis as pointed out by the authors3. It has been shown previously that internal thoracic artery grafts can be effectively used when there is no lesion in the subclavian4. We would like to reiterate the importance of identifying ostial stenosis during surgery in this group of patients, it is also important to start the patients on steroids to prevent postoperative inflammatory coronary ostial stenosis.

REFERENCES

  1. Chau MCE, Wang E, Chin SWC, Chow WH. Non infectious aortitis: an important cause of severe aortic regurgitation. Asian Cardiovasc Thorac Ann 2006;14:177–82.[Abstract/Free Full Text]

  2. Vaidyanathan KR, Byalal JR, Sunderamoorthi T et al. Rapidly progressive coronary ostial stenosis after aortic valve replacement in relapsing polychondritis. J Thorac Cardiovasc Surg 2006;131:1395.[Free Full Text]

  3. Amano J, Suzuki A. Coronary artery involvement in Takayasu’s arterits. Collective review and guidelines in surgical management. J Thorac Cardiovasc Surg 1991;102:554–60.[Abstract]

  4. Endo M, Tomizawa Y, Nishida H et al. Angiographic findings and surgical treatments of coronary artery involvement in Takayasu arteritis. J Thorac Cardiovasc Surg 2003;125:570–7.[Abstract/Free Full Text]





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