Chest
Volume 99, Issue 2, February 1991, Pages 508-510
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Selected Reports
Regression of the Left Main Trunk Lesion by Steroid Administration in Takayasu's Aortitis

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A 62-year-old man with unstable angina due to severe narrowing of the left main trunk (LMT) was examined. Emergency bypass surgery was performed with an internal mammary artery graft, instead of a saphenous vein graft, because of the thickened, edematous ascending aorta. Postoperative coronary angiography showed the lesion of the LMT markedly regressing. Presumably, this stenotic lesion of the LMT was caused by active aortitis and was partially reversible by steroid administration both during and after surgery. Steroid therapy can be added to the list of treatments for cases of LMT disease associated with Takayasu's aortitis, if signs of active inflammation are present.

Section snippets

CASE REPORT

A 62-year-old man had noticed an oppressive sensation in his chest upon exertion since March 1989. On May 23, 1989, the sensation had lasted for ten hours, and he was transferred to this hospital. The peak creatine phosphokinase level was 796 IU, but no new abnormal Q waves developed on electrocardiography. After admission, he remained free from angina pectoris with nitrates, calcium antagonists, and β-adrenergic blockers. The level of CRP was 5.5 mg/dl, and normocytic and normochromic anemia

DISCUSSION

A severe LMT lesion, persistently abnormal CRP levels, and the thickened, edematous ascending aorta, as seen during surgery in this case, are characteristic of Takayasu's aortitis. Surgical therapy for Takayasu's aortitis during the active phase carries great risk. Generally, aortic valve replacement is postponed until inflammation has subsided with steroid therapy.1 Cherin et al2 reported a case of reversible coronary stenosis after steroid administration. The regression was suspected by

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