A Case of Pulmonary Artery Bypass Surgery for a Patient with Isolated Takayasu Pulmonary Arteritis and a Review of the Literature

Nobuyuki Nakajima, MD,1 Masahisa Masuda, MD,1 Mizuho Imamaki, MD,1 Atsushi Ishida, MD,1 Nobuhiro Tanabe, MD,2 and Takayasu Kuriyama, MD2

A 45-year-old female was presented with progressive dyspnea and bilateral leg edema. Pulmonary angiography revealed total occlusion of the right pulmonary artery and significant stenosis of the left pulmonary artery. The inferior lobar artery as well as the segmental arteries were well patent. No pathology was detected elsewhere at the aorta and its branches. The diagnosis of chronic pulmonary arterial occlusion by isolated Takayasu arteritis was made because of the characteristic pattern of angiographic findings and the presence of unusual shunt formation from the coronary artery to the peripheral portion of the pulmonary artery, as well as a characteristic presentation of HLA typing in blood analysis, which strongly suggested the diagnosis of Takayasu arteritis. To restore the pulmonary blood flow, we employed reconstructive surgery by means of bypass procedure, using PTFE graft. Postoperatively there was marked improvement in cardiopulmonary function and the quality of life of the patient. The graft was proved to be patent at long-term follow-up study. An extremely rare case of chronic occlusive pulmonary arteritis, which was surgically treated by means of bypass procedure, is reported herein, and a brief review of previous reports on this subject was attempted. (Ann Thorac Cardiovasc Surg 2007; 13: 267-271)

Key words: Takayasu arteritis, isolated pulmonary arteritis, pulmonary artery, pulmonary artery bypass surgery

1Cardiovascular Surgical Service, Department of Surgery, and 2Department of Respirology, Chiba Graduate School of Medicine, Chiba, Japan

Received September 13, 2006; accepted for publication December 15, 2006
Address reprint requests to Nobuyuki Nakajima, MD: Kashima Rosai Hospital, Japan Labor Health and Welfare Organization, 1–9108–2 Doaihoncho, Kamisu, Ibaraki 314–0343, Japan.