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Kowatari R, Minakawa M, Daitoku K, Suzuki Y, Fukuda I. Coronary artery bypass for Takayasu's arteritis involving the aortic root in a child. J Card Surg 2021; 36:2127-2129. [PMID: 33590549 DOI: 10.1111/jocs.15425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 11/28/2022]
Abstract
The patient was a 12-year-old female who presented with angina pectoris, aortic root dilatation, and aortic regurgitation (AR) caused by Takayasu's arteritis (TA). After the management of systemic inflammation, she underwent off-pump coronary artery bypass with the radial artery (RA), which extended from the left axillary artery to the left descending coronary artery, via left mini-thoracotomy. Postoperative angiography revealed the growth of the RA graft. The patient is well 4 years after surgery without progression of AR. Off-pump coronary artery bypass is a palliative therapy. Moreover, it could be a feasible option in a child with TA involving the aortic root.
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Affiliation(s)
- Ryosuke Kowatari
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Masahito Minakawa
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Kazuyuki Daitoku
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Yasuyuki Suzuki
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Ikuo Fukuda
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
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Saling LJ, Raptis DA, Parekh K, Rockefeller TA, Sheybani EF, Bhalla S. Abnormalities of the Coronary Arteries in Children: Looking beyond the Origins. Radiographics 2017; 37:1665-1678. [PMID: 29019754 DOI: 10.1148/rg.2017170018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Coronary arterial abnormalities are uncommon findings in children that have profound clinical implications. Although anomalies of the coronary origins are well described, there are many other disease processes that affect the coronary arteries. Immune system-mediated diseases (eg, Kawasaki disease, polyarteritis nodosa, and other vasculiditides) can result in coronary arterial aneurysms, strictures, and abnormal tapering of the vessels. Because findings at imaging are an important component of diagnosis in these diseases, the radiologist's understanding of them is essential. Congenital anomalies may present at varying ages, and findings in hemodynamically significant anomalies, such as fistulas, are key for both diagnosis and preoperative planning. Pediatric heart surgery can result in wide-ranging postoperative imaging appearances of the coronary arteries and also predisposes patients to a multitude of complications affecting the heart and coronary arteries. In addition, although rare, accidental trauma can lead to injury of the coronary arteries, and awareness and detection of these conditions are important for diagnosis in the acute setting. Patients with coronary arterial conditions at presentation may range from being asymptomatic to having findings of myocardial infarction. Recognition of the imaging findings is essential to direct appropriate treatment. ©RSNA, 2017.
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Affiliation(s)
- Lauren J Saling
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Demetrios A Raptis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Keyur Parekh
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Toby A Rockefeller
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Elizabeth F Sheybani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
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Mohan S, Poff S, Torok KS. Coronary artery involvement in pediatric Takayasu's arteritis: Case report and literature review. Pediatr Rheumatol Online J 2013; 11:4. [PMID: 23398983 PMCID: PMC3575318 DOI: 10.1186/1546-0096-11-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 02/05/2013] [Indexed: 11/29/2022] Open
Abstract
Takayasu's arteritis (TA) is a form of chronic vasculitis that typically occurs in young adult Asian females, but it can also present in younger patients not fitting this classic profile. In these cases, the sequelae are generally similar to those found in adults. The disease predominantly affects the aorta and its primary branches. However, the coronary arteries are also affected in up to 20% of cases, which may precipitate myocardial infarction. Imaging of the coronary arteries therefore becomes critically important in the evaluation of a patient with possible Takayasu's arteritis. We present a case of a pediatric patient with TA who had no symptoms of angina but who was found to have significant coronary artery involvement on diagnostic imaging. This necessitated tailoring of traditional management.
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Affiliation(s)
- Shaun Mohan
- Division of Pediatric Rheumatology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, 15224, Pittsburgh, PA, USA.
| | - Sarah Poff
- Division of Pediatric Rheumatology, Children’s Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, 15224, Pittsburgh, PA, USA
| | - Kathryn S Torok
- Division of Pediatric Rheumatology, Children’s Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, 15224, Pittsburgh, PA, USA
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McBrien A, Griselli M, Friswell M, Hasan A, Kirk R. Heart transplantation following myocardial infarction due to Takayasu's arteritis. Pediatr Transplant 2012; 16:E291-5. [PMID: 22118423 DOI: 10.1111/j.1399-3046.2011.01616.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We report a 14-yr-old girl who presented with cardiogenic shock because of compression of the left main coronary artery secondary to Takayasu's arteritis. The patient required cardiac transplantation with hemi-arch replacement at the time of transplant because of ascending aortitis. To our knowledge, this is the first case of cardiac transplantation in Takayasu's arteritis to be reported in the literature.
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Affiliation(s)
- Angela McBrien
- Department of Paediatric Cardiology, Freeman Hospital, Newcastle upon Tyne, UK.
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