Five Vessel Coronary Arter Bypass Graft Surgery in a Case with Familial Hypercholesterolemia

Year 2014, Volume: 39 Issue: 4, 0 - , 22.07.2014

Süreyya Talay Burçin Abud

https://doi.org/10.17826/cutf.11673

Abstract

We report a case of a rare and sypmtomatic familyal hypercholesterolemia case with an end-point of coronary artery bypass surgery at the age of 16. Patient was evaluated at the emergency department with chest pain and discomfort. Physical examination were within normal limits. The electrocardiogram showed a normal sinus rhythm for 108/ min. Arterial blood pressure was 90/60 mmHg. Lungs and heart were clear to auscultation. Patient was under treatment with a prior diagnosis of familial hypercholesterolemia (FH) for one year by daily 40 mgs rosuvastatine. A coronary artery angiography was performed for chest pain. Multivessel coronary artery disease was diagnosed with a total occlusion of left anterior descending artery. Transthoracic echocardiography presented a left ventricular (LV) ejection fraction 50%, LV diameters 44/26 mm, aneurysm formation at interatrial septum and mild dyskinesia of anterior wall. Thus, a five vessel emergent coronary artery graft bypass surgery was performed at this early age. FH is with a severe elevation in total cholesterol (TC) and low density lipoprotein cholesterol (LDL) in an autosomal dominant characteristic disorder that approximately occurs in 1 per 500 persons by its heterozygous form. FH is most certainly associated with premature coronary artery disease (CAD) with catasthrophic early age results.

Keywords

Familial hypercholesterolemia, coronary artery bypass surgery, early age

Familyal Hiperkolesterolemisi Olan Bir Hastada Beş Damar Koroner Arter Bypass Cerrahisi

Abstract

Koroner arter bypass cerrahisi uygulanan familyal hiperkolesterolemili 16 yaşında bir hasta sunmaktayız. Acil servisimize göğüs ağrısı şikayeti ile başvuran hastanın fizik muayenesi olağandı. Elektrokardiyogram sinüs ritminde, kalp hızı dakikada 108 idi. Kan basıncı 90/60 mmHg olan hastanın kardiak ve solunumsal dinleme bulguları olağandı. Hasta 1 yıl önce familyal hiperkolesterolemi tanısı almış, bu sebeble günlük 40mg rosuvastatin kullanıyordu. Şikayetleri sebebiyle hastaya koroner anjiografi uygulandı ve sol ön inen koroner arterin (LAD) total oklüzyonunu içeren multidamar koroner arter hastalığı olduğu saptandı. Transtorasik ekokardiyografide ejeksiyon fraksiyonu %50, sol ventrikül çapları 26/44 mm ve ön duvarda orta diskinezi mevcuttu. Böylelikle bu genç hastaya beş damar koroner arter bypass cerrahisi uygulandı. Familyal hiperkolesterolemi düşük dansiteli lipoprotein (LDL) ve total kolesterolün ciddi oranda yükseldiği otosomal dominant bir hastalık olup, heterozigot formu 500 de 1 görülmektedir. Familyal hiperkolesterolomi genellikle erken yaşta mortaliteye yol olmaktadır, bununda sebebi erken yaşta meydana gelen koroner arter hastalığıdır.

Keywords

Familyal hiperkolesterolomi, koroner arter bypass cerrahisi, erken yaş

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• Yazışma Adresi / Address for Correspondence: Dr.Burçin Abud İzmir Tepecik Research and Education Hospital Cardivascular Surgery İZMİR E-mail: [e-mail]. G eliş tarihi/received : 07.01.2014
• Kabul tarihi/accepted:14.02.2014