Antiphospholipid syndrome with chronic thromboembolic pulmonary hypertension and coronary artery disease: a case report
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(2020) 15:225
CASE REPORT
Open Access
Antiphospholipid syndrome with chronic thromboembolic pulmonary hypertension and coronary artery disease: a case report Kayo Sugiyama1* , Shun Suzuki2, Nobusato Koizumi2 and Hitoshi Ogino2
Abstract Background: Antiphospholipid syndrome (APS) is characterized by the production of antiphospholipid antibodies associated with recurrent vascular thrombosis. There have been few reports of combination of chronic thromboembolic pulmonary hypertension (CTEPH) and coronary artery disease in APS, therefore, it is unclear about appropriate treatment strategy. Case presentation: The patient was a 39 year-old-lady who had been suffering from hypoxia without chest pain. Transthoracic echocardiography showed severe pulmonary hypertension and mild hypokinesis of left ventricular anteroseptal wall. Simultaneously with the diagnosis of CTEPH, coronary angiography revealed severe stenosis of the left anterior descending artery. She underwent pulmonary endarterectomy (PEA) concomitant with coronary artery bypass grafting (CABG) successfully. CABG could be performed concomitantly during rewarming. During perioperative period, she was free from any thromboembolic and bleeding events despite receiving anticoagulant and antiplatelet therapies. Conclusions: PEA concomitant with coronary artery bypass grafting was feasible for APS patients complicated with CTEPH and coronary artery disease. APS patients with the presence of left ventricular dysfunction should be evaluated for coronary artery disease. Keywords: Antiphospholipid syndrome, Chronic thromboembolic pulmonary hypertension, Pulmonary endarterectomy, Coronary artery bypass grafting
Background Antiphospholipid syndrome (APS) is diagnosed based on both clinical criteria and laboratory criteria [1, 2]. The clinical signs include recurrent arterial and venous thrombosis [1]. APS occurs in about 15–50% chronic thromboembolic pulmonary hypertension (CTEPH) patients [3]. Surgical treatment for severe CTEPH with APS is still challenging because the perioperative management may be complicated due to the presence of thrombotic events and bleeding * Correspondence: [email protected] 1 Department of Cardiac Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan Full list of author information is available at the end of the article
complications [1, 4, 5]. Otherwise there is a risk that coronary artery disease may be overlooked in CTEPH patients with APS. Evaluation of coronary artery disease should be considered in symptomatic APS patients; however, sometimes coronary angiography is necessary even in asymptomatic patients. Ballon pulmonary angioplasty (BPA) has been known as an effective endovascular treatment; however, its effectiveness is limited to only distal lesions, and PEA is the most appropriate treatment for CTEP H with central lesions [6]. Because in PEA, the patients have to be cooled down to 18 °C [7], rewarming requires more than 1 h. Therefore, concomitant procedures can be usually performed during rewarm
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