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J Thorac Cardiovasc Surg 2003;125:570-577
© 2003 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Angiographic findings and surgical treatments of coronary artery involvement in Takayasu arteritis

From the Departments of Cardiovascular Surgery,^a Pediatric Cardiology,^b Cardiology,^c Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.

Received for publication April 16, 2002. Revisions requested July 10, 2002; revisions received Aug 4, 2002. Accepted for publication Aug 28, 2002. Address for reprints: Masahiro Endo, MD, Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, 8-1, Kawada, Shinjuku, Tokyo 162-8666, Japan (E-mail: ENDO{at}hij.twmu.ac.jp).

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.
Conclusion: 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.

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