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Ann Thorac Surg 2000;69:316
© 2000 The Society of Thoracic Surgeons

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Correspondence

Bypass grafts in Takayasu’s disease

^a University Department of Cardiac Surgery, The Royal Infirmary, 10 Alexandra Parade, Glasgow, Scotland G31 2ER, United Kingdom

e-mail: pbelcher{at}clinmed.gla.ac.uk

To the Editor

The two cases reported by Lall and associates [1], which included one child with Takayasu’s aortitis, raise the problem of using the internal mammary artery for bypass grafting in this disease. The mainstay of management should indeed be treatment of the ostial stenosis, as peripheral coronary lesions are very rare in Takayasu’s [2]. However, it should be remembered that major branches of the aortic arch are particularly affected in this disease. A study of 321 cases in Japan showed that the disease affected, in order of frequency, the left subclavian and carotid artery, next the right subclavian, followed by the abdominal and thoracic aorta [3]; not for nothing is it known as pulseless disease. Thus, the long-term outlook for any pedicled arterial graft, especially the mammary, is uncertain. This consideration, and the fact that the right coronary angioplasty is technically far easier, led us to carry out right coronary pericardial patch angioplasty, which was then used as a base for a saphenous vein graft to the only graftable part of the left coronary system [4, 5]. In retrospect, a free mammary graft would have been more appropriate.

References

1. Lall K.S., Dombrowicz E., Pillay T.M., Pollock J.C.S. Coronary ostial patch angioplasty in children. Ann Thorac Surg 1999;67:1478-1480.[Abstract/Free Full Text]
2. Takayasu M. Case of queer changes in central blood vessels of retina. Acta Soc Ophthalmol Jap 1908;12:554-562.
3. Ueda H., Ito I., Saito Y. Studies on arteritis, with special reference to pulseless disease and its diagnosis. Naika 1965;15:239-256.
4. Morgan J.M., Honey M., Gray H.H., Belcher P., Paneth M. Angina pectoris in a case of Takayasu’s disease. Eur Heart J 1987;8:1354-1358.
5. Belcher P.R., Morgan J.M. Aorta-coronary bypass grafting for Takayasu’s aortitis. J Thorac Cardiovasc Surg 1992;103:389.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Philip R. Belcher Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Belcher, P. R. Search for Related Content PubMed PubMed Citation Articles by Belcher, P. R.