PDF(Pubmed)
Abstract：
Coronary artery aneurysms (CAAs) due to an immunoglobulin G4 (IgG4)-related disease (IgG4-RD) are relatively rare, and there is no consensus on the choice of treatment method. In the present study, we report the results of the surgical treatment for multiple giant CAAs caused by IgG4-RD. A 71-year-old man was diagnosed with severe aortic regurgitation and CAAs. A blood test showed high IgG4 levels, and computed tomography revealed four giant coronary artery aneurysms: two in the right coronary artery (RCA) (proximal RCA and posterior descending artery (PDA)), one in the left anterior descending (LAD), and one in the diagonal branch (Dx). We planned aortic valve replacement, coronary aneurysm resection, and coronary artery bypass grafting (CABG). After finishing aortic valve replacement, the CAAs in proximal RCA, LAD, and Dx were resected. The proximal and distal tracts of the aneurysm were closed with a pericardial bovine patch and ligation. However, since the distal PDA was too calcified to be anastomosed, and the PDA aneurysm was smaller than the others, it was decided to leave the PDA aneurysm. The anastomoses of SVG-RCA and Dx, as well as the left internal thoracic artery to LAD, were performed. Histopathological examination of the aneurysm wall showed a high IgG4-positive cell/IgG-positive cell ratio, and a diagnosis of IgG4-RD was made. In the treatment of CAAs due to IgG4-RD, it is essential to select a procedure that takes into account the size, location, and nature of the aneurysm, and comorbidities. To ensure resection of the aneurysm and blockade of blood flow, closure of the inflow and outflow tracts with a pericardial bovine patch and CABG are effective.
摘要：
由于免疫球蛋白G4（IgG4）相关疾病（IgG4-RD）引起的冠状动脉瘤（CAA）相对罕见，治疗方法的选择没有共识。在本研究中,我们报告了IgG4-RD引起的多个巨大CAAs的手术治疗结果。一名71岁的男子被诊断为严重的主动脉瓣反流和CAA。血液检查显示IgG4水平很高,计算机断层扫描显示四个巨大的冠状动脉瘤：两个在右冠状动脉（RCA）（近端RCA和后降支（PDA）），一个在左前降支（LAD），和一个在对角分支(Dx)。我们计划进行主动脉瓣置换术,冠状动脉瘤切除术,冠状动脉旁路移植术（CABG）。主动脉瓣置换术后，近端RCA的CAA，LAD,Dx被切除。用心包牛补片和结扎封闭动脉瘤的近端和远端。然而,由于远端PDA钙化太多，无法吻合，PDA动脉瘤比其他动脉瘤小，决定离开PDA动脉瘤.SVG-RCA和Dx的吻合，以及左胸内动脉到LAD,被执行了。动脉瘤壁的组织病理学检查显示高IgG4阳性细胞/IgG阳性细胞比率，并诊断为IgG4-RD。在治疗因IgG4-RD引起的CAAs时，选择一个考虑到大小的程序是至关重要的，location,和动脉瘤的性质，和合并症。为了确保切除动脉瘤和阻断血流，用心包牛补片和CABG封闭流入和流出道是有效的。
