2011; 11: 368-72
mented in childhood period (4). Conventional CABG is usually performed in children; off-pump CABG is rarely preferred for use in pediatric patients because of the small diameter of their vessels (5).
Extracardiac vascular involvement (including that involving the aortic root and carotid artery) has been documented in children with familial hypercholesterolemia and the incidence of such involvement increases with the age of the patient. Evaluation for atherosclerosis of the aorta is not routinely performed preoperatively in children, although atheroembolism from the ascending aorta is a major etiologic factor for stroke in adult patients undergoing cardiac surgery. Cohen et al. (6) showed that non calcified plaques are associated with a higher risk of vascular events and surgical manipulation has been reported to cause new mobile lesions in a diseased aorta (7). Soft atheromas are most likely to embolized as a result of manipulation. In our patient, the preoperatively detected atheromatous ascending aorta led us to prefer the use of off-pump CABG, because the non calcified, unstable, lipid-laden plaques were thought to have the potential to form emboli.
To prevent procedure-related neurologic complications, the possibility of diffuse and dense atherosclerosis of the ascending aorta must be kept in mind in children with familial hypercholesterolemia who undergo CABG.
Marais AD, Firth JC, Blom DJ. Homozygous familial hypercholesterolemia and its management. Semin Vasc Med 2004; 4: 43-50.
Ribeiro P, Shapiro LM, Gonzalez A, Thompson GR, Oakley CM. Cross sectional echocardiographic assessment of the aortic root and coronary ostial stenosis in familial hypercholesterolaemia. Br Heart J 1983; 50: 432-7.
Kitamura S, Seki T, Kawachi K, Morita R, Kawata T, Mizuquchi K, et al.
Excellent patency and growth potential of internal mammary artery grafts in pediatric coronary artery bypass surgery. New evidence for a "live" conduit. Circulation 1988; 78: I129-39.
Göksel OS, Tireli E, El H, Oflaz H, Dayıoğlu E. Coronary artery bypass grafting in a 12-year-old girl with familial hypercholesterolemia. Acta Chir Belg
2009; 109: 117-8.
Nabuchi A, Sonobe T. Minimally invasive coronary artery bypass grafting surgery in a child with Kawasaki disease. Jpn J Thorac Cardiovasc Surg
2001; 49: 82-4.
Cohen A, Tzourio C, Bertrand B, Chauvel C, Bousser MG, Amarenco P.
Aortic plaque morphology and vascular events: a follow-up study in patients with ischemic stroke. FAPS Investigators. French Study of Aortic
Plaques in Stroke. Circulation 1997; 96: 3838-41.
Ura M, Sakata R, Nakayama Y, Goto T. Ultrasonographic demonstration of manipulation-related aortic injuries after cardiac surgery. J Am Coll Cardiol
2000; 35: 1303-10.
Address for Correspondence/Yaz›şma Adresi: Dr. Öner Gülcan
Department of Cardiovascular Surgery, Adana Teaching and Medical Research
Center, Başkent University, Adana-Turkey
Phone: +90 322 327 27 27 Fax: +90 322 327 12 73 E-mail: firstname.lastname@example.org
Available Online Date/Çevrimiçi Yayın Tarihi: 18.05.2011
©Telif Hakk› 2011 AVES Yay›nc›l›k Ltd. Şti. - Makale metnine www.anakarder.com web sayfas›ndan ulaş›labilir.
©Copyright 2011 by AVES Yay›nc›l›k Ltd. - Available on-line at www.anakarder.com doi:10.5152/akd.2011.090 Olgu Sunumları
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