Coronary artery bypass surgery with arterial grafts in familial hypercholesterolemia

Surgical Challenges of Familial Hypercholesterolemia

A 21-year-old patient with familial hypercholesterolemia presented with angina caused by ostial stenosis of the left internal mammary artery and severe calcific aortic stenosis with small aortic root 9 years after coronary revascularization. The ostium of the left internal mammary artery was enlarged using a saphenous vein patch through a left supraclavicular incision, which improved left ventricular function. Successful aortic valve replacement with posterior aortic root enlargement was subsequently performed. The surgical management of this condition is discussed briefly.

Coronary insufficiency in children: Review of literature and report of a rare case with unknown aetiology

Myocardial ischemia due to coronary artery disease is a rare condition in children. The reported causes of this condition include vasculitis; commonest being Kawasaki' disease, pre-mature atherosclerosis due to familial dyslipidemias, congenital coronary artery anomalies and post-operative complications of procedures requiring coronary artery re-implantation in children, e.g. arterial switch procedure and Ross procedure. Allograft arteriopathy after heart transplantation is a more recent addition to this list (Mavroudis et al., 1996). Surgical procedures required for the treatment of coronary artery disease in children include, but are not limited to coronary artery re-implantation, re-routing, augmentation of the osteum, and coronary artery bypass grafting (CABG). We present our experience of a rare case of triple vessel coronary artery disease of unknown aetiology in a child, treated with coronary artery bypass grafting procedure.

Triple Vessel Coronary Artery Bypass Grafting in a 14-year-old Child with Familial Hypercholesterolemia-A Rare Case Report

Familial hypercholesterolemia is a genetic disorder caused by a mutation in the low density lipoprotein (LDL) receptor gene. The homozygous type of the disease is rare and causes tendon xanthomas and coronary artery disease during the early years of life. Premature coronary artery occlusive disease in familial homozygous hypercholesterolemia might necessitate coronary bypass surgery in children and young adults We present the case of a 14-year-old boy with familial hypercholesterolemia and coronary artery disease. He underwent triple-vessel coronary artery bypass grafting with bilateral pedicled internal mammary artery and saphenous vein grafting without adverse events. Pediatric patients with familial hypercholesterolemia may present with premature coronary atherosclerosis requiring coronary artery bypass grafting. In situ internal mammary artery grafts should be the graft of choice. To the best of our knowledge, he is one of the youngest such patients reported in the English-language literature who underwent coronary artery bypass surgery.

Triple Coronary Bypass in a Child with Homozygous Familial Hypercholesterolemia

Here we report triple coronary bypass procedure in a 12-year-old girl with familial homozygous hypercholesterolemia and extensive coronary atherosclerosis. She had successful cardiopulmonary resuscitation at home by her father 4 months before the operation. Total cholesterol level was 1300 mg/dL initially without antilipidemic treatment. Extensive three vessel disease with right coronary proximal stenosis and left coronary ostial stenoses was determined by angiography. Left internal thoracic artery, left radial artery, and saphenous vein grafts were used for coronary revascularization. Saphenous vein graft to right posterior descending artery, radial artery graft to obtuse marginal artery, and LITA to left anterior descending artery anastomoses were performed consecutively. Ten months after the operation, she is in good condition under intensive antilipidemic therapy and weekly lipid apheresis.