Angiographic findings and surgical treatments of coronary artery involvement in Takayasu arteritis.
BACKGROUND
Takayasu arteritis is associated with a low incidence of coronary artery involvement, such as stenosis, obstruction, aneurysm, and coronary steal syndrome, but coronary ischemia can be fatal.


METHODS
Between 1972 and April 2001, 81 of 130 patients given a diagnosis of Takayasu arteritis underwent selective coronary angiography, and among them, 31 patients (4 male and 27 female patients; mean age, 41.1 +/- 13.2 years) had abnormal coronary angiographic findings and were recruited for this study.


RESULTS
Abnormal coronary findings consisted of 24 coronary artery stenoses of greater than 75%, 3 coronary artery-bronchial artery anastomoses, 3 aneurysmal coronary ectasias, and 1 combined coronary ectasia and anastomosis. Among 24 patients with coronary stenosis, the ostium was most frequently involved (87.5%). Twenty-three of 24 patients with coronary artery stenoses were treated surgically. The mean follow-up duration was 9.65 +/- 6.9 years, with a 100% follow-up rate. Four fistulas and 4 aneurysms in 7 patients were not treated surgically. Coronary steal phenomenon was always associated with occluded pulmonary arteries and pulmonary hypertension. Aneurysmal coronary ectasia was related to severe aortic hypertension with or without aortic regurgitation and atypical coarctation. There were 2 (8.7%) in-hospital deaths and 3 (13%) late deaths. The actuarial survival rate, including in-hospital deaths, was 86.5% +/- 7.3% at 5 years and 81.4% +/- 8.4% at 10 years.


CONCLUSIONS
The incidence of coronary abnormalities is relatively low in patients with Takayasu arteritis; however, surgical treatment is recommended for patients with coronary ostial stenoses because coronary ischemia can be one of the major causes of death.
Endo
Masahiro
M
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Japan. ENDO@hij.twmu.ac.jp
Tomizawa
Yasuko
Y
Nishida
Hiroshi
H
Aomi
Shigeyuki
S
Nakazawa
Makoto
M
Tsurumi
Yukio
Y
Kawana
Masatoshi
M
Kasanuki
Hiroshi
H
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D001017:Aortic Coarctation / Q000209:etiology; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001159:Arterio-Arterial Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery; D001981:Bronchial Arteries; D002423:Cause of Death; D002648:Child; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery; D004691:Endarterectomy; D005260:Female; D005500:Follow-Up Studies; D006680:HLA Antigens / Q000235:genetics; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D013625:Takayasu Arteritis / Q000150:complications* / Q000235:genetics; D016896:Treatment Outcome
D006680:HLA Antigens