Publication Date

6-1-2019

Journal

The Texas Heart Institute Journal

DOI

10.14503/THIJ-16-5824

PMID

31708705

Publication Date(s)

June 2019

Language

English

PMCID

PMC6827467

PubMedCentral® Posted Date

6-1-2019

PubMedCentral® Full Text Version

Post Print

Published Open-Access

yes

Keywords

Adolescent, Blood Vessel Prosthesis Implantation, Coronary Angiography, Electrocardiography, Fatal Outcome, Graft Occlusion, Vascular, Humans, Male, Myocardial Infarction, Percutaneous Coronary Intervention, Takayasu Arteritis, Ultrasonography, Interventional

Abstract

Anastomotic occlusion of an interposed coronary artery graft after a Bentall procedure is rare and catastrophic. It can lead to myocardial infarction or sudden cardiac death. We found several reports of occlusion and stenosis of a coronary-graft anastomosis, but few describe occlusion of the interposed coronary graft itself, as evaluated with use of intracoronary ultrasonography and computed tomography. We report the case of a 17-year-old boy with Takayasu arteritis who had a myocardial infarction caused by severe ostial stenosis in an interposed left coronary graft. The graft occlusion was confirmed by results of electrocardiography, aortography, and intracoronary ultrasonography. The patient was treated with percutaneous coronary intervention, stenting of the interposed graft, and thrombectomy, but he died of left ventricular dysfunction caused by extensive myocardial infarction. Extrinsic compression may have caused the graft occlusion. When considering emergency percutaneous coronary intervention to interposed coronary artery grafts, operators need to identify the cause of occlusion and decide on the best approach for each patient. Stenting the graft may provide temporary relief. During a hemodynamic crisis, immediately reperfusing the graft is crucial.

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