Takayasu's Arteritis with Ostial and Left Main Coronary Artery Stenosis

Takayasu's arteritis with coronary artery involvement is rare, and there is little published information on the subject. Coronary angiographic and histopathologic studies have revealed coronary artery lesions in 9% to 11% of cases. Coronary artery involvement consists mostly of stenosis or occlusion of the coronary ostia. We report the case of a 19-year-old woman who presented with crescendo angina. Upon investigation, we found that our patient had ostial and left main coronary arterial stenosis with left-dominant circulation; therefore, we decided that an arterial Y graft, performed on a beating heart, would provide better perfusion to the compromised myocardium than would a single graft to the left anterior descending artery. In addition, use of the Y graft obviated the need to perform a proximal anastomosis on an inflamed, edematous ascending aorta, and it conferred long-term graft patency of the internal mammary arteries. Timely coronary artery bypass grafting relieved our patient's angina, and in early follow-up she has shown good effort tolerance.