[A case of coronary artery bypass grafting using bilateral mammary arteries in a patient with systemic lupus erythematosus].

A 40-year-old female who had been treated with steroid for 10 years because of systemic lupus erythematosus (SLE) was admitted to our department for triple-vessel disease with LMT lesion. She underwent bilateral internal mammary artery grafting to the right ventricular branch of RCA and the No. 7 segment of LAD. Intraoperative free flow was 70 ml/min in both bypass grafts. She dropped to severe shock with a high fever of 40 degrees C and decreased the white blood cell count of 900/mm3 on the 6th postoperative day. These clinical and laboratory findings were suggestive of rebound phenomenon of SLE or withdrawal syndrome of steroid therapy. She was treated with pulse therapy of methyl-prednisolone and her condition improved in two weeks. Histological findings of the right internal mammary artery revealed stenotic lesion of about 50%, but on June 24, 1988, postoperative angiography showed a good patency of both internal mammary arteries. Only a few reports of successful attempt of coronary artery bypass grafting for coronary lesion due to SLE are available in the literature. Some important problems concerning the surgical treatment as well as the therapy of steroid involved in this case were discussed.