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At least 181 records · Page 10Linked to original sources

Psoriasis, sacroiliitis, and aortitis: an echocardiographic mimic of aortic root dissection.

A patient with psoriasis, HLA-B27-positive sacroiliitis, and aortitis presented with clinical features suggesting acute aortic dissecting aneurysm. Although M-mode and two dimensional echocardiography supported the diagnosis, dissection was excluded by angiography and by direct observation at surgery. Asymmetric thickening of the right coronary cusp secondary to psoriatic aortitis was found to be etiologic of both the regurgitation and the false-positive echo for dissection. It is emphasized that in the setting of any fibrocalcific or inflammatory disease of the aorta, the echo diagnosis of dissection is fraught with hazard.

Aortic Dissection↗

Coronary artery aneurysm associated with aortitis syndrome diagnosed pre- and intraoperatively.

Aneurysm of the coronary artery associated with aortitis syndrome is extremely rare. This is a case report of a left coronary artery aneurysm associated with aortitis syndrome. The patient was a 47-year-old woman who complained of palpitation and dizziness on exertion. Aortogram revealed occlusion of the arch vessels, infrarenal aortic stenosis, and a fusiform aneurysm of the left coronary artery. There was neither an intraluminal thrombus nor occlusive changes in the coronary arteries. Severe systolic hypertension nearing 300 mmHg was present in the ascending aorta. Severe hypertension and direct extension of inflammation to the coronary artery seemed to be important factors for the formation of the aneurysm. To resolve the severe hypertension, a bypass operation between the ascending aorta and the abdominal aorta distal to the stenosis was performed. The postoperative course was uneventful and blood pressure was reduced.

Aneurysm↗

Rapid progression of an aortic lesion in a patient with aortitis syndrome.

In a 28-year-old woman with aortitis syndrome, repeated aortography revealed the development of a coarctation of the abdominal aorta occurring over a period of 1 year. Clinical and surgical examinations showed evidence of inflammation and ruled out other diseases during that time. This suggests that in cases of aortitis syndrome arterial lesions may show rapid progression over short time periods and in the absence of untoward events.

Adult↗

Aortic dissection associated with aortitis syndrome.

A 50-year-old woman with aortitis syndrome complicated by aortic dissection, is reported. The dissection was observed at the level of the descending thoracic aorta by aortography and at the intimal side of the dilated aorta on CT. An aneurysm of the right subclavian artery and a diffusely thick wall of the abdominal aorta were also observed. This case suggests that the uneven wall of the aorta in aortitis syndrome might be dissected at the intimal side by dilatation.

Aneurysm↗

A case of aortitis syndrome and IgA nephropathy: possible role of human leukocyte antigens in both diseases.

A 51-year-old woman, who had both aortitis syndrome (Takayasu arteritis) and IgA nephropathy, presented with hypertension, fever, a high erythrocyte sedimentation rate, high C-reactive protein and serum IgG levels, proteinuria, and renal dysfunction. Renal arteriography showed stenosis and poststenotic dilatation at the origin of the right renal artery, as well as tortuosity of the left renal artery branches and marked atrophy of the left kidney. Renal biopsy showed IgA nephropathy with deposits of IgA, C3, and fibrinogen in the glomeruli and arteriolosclerosis. The present patient had human leukocyte antigen (HLA)-B 52, which is reported to be related to the aortitis syndrome, as well as HLA-DR 4, which is possibly related to IgA nephropathy, suggesting that HLA status may be involved in the pathogenesis of both diseases.

Adult↗

Saccular aneurysm of ascending aorta caused by granulomatous aortitis in a child.

This report describes a 7-year-old boy who underwent successful surgical excision of a saccular aneurysm of the ascending aorta caused by giant cell aortitis. The aneurysm was removed by lateral aortorrhaphy without cardiopulmonary bypass. The clinical manifestations and appropriate surgical therapy of granulomatous aortitis in childhood are discussed.

Aortic Aneurysm↗

[Combined intercostal nerve block and epidural anesthesia in a patient with severe aortitis syndrome].

A 74-year-old woman with aortitis syndrome was scheduled for mastectomy. Her left vertebral artery was totally occluded and left carotid arteries, left subclavia artery and bilateral common renal arteries were occluded. For anesthesia a catheter was inserted into the epidural space between T3 and T4. Lidocaine 80 mg (2%, 4 ml) was administered epidurally. Then intercostal nerve block was performed with bupivacaine 15 mg (0.5%, 3 ml) at T3 and T4 level. Local infiltration of lidocaine 50 mg (1%, 5 ml) was added. During the surgery, hemodynamics were stable and no neurological symptom was observed. Epidural anesthesia alone might be sufficient for anesthesia if higher concentration of local anesthetic was used. However, to avoid hemodynamic change, we used 1% lidocaine and added intercostal nerve block. We conclude that combined intercostal nerve block and epidural anesthesia was useful for a patient with severe aortitis syndrome in oder to monitor consciousness to detect cerebral ischemia and to avoid hemodynamic instability.

Aged↗

Initial appearance of an ill-defined shadow on a chest roentgenogram in a patient with aortitis syndrome.

A 20-years-old woman with fever and an abnormal shadow on a chest roentgenogram was admitted to our hospital. High grade fever continued even after gradual disappearance of the ill-defined shadow on the right upper lobe (S3) with minor fissure deviation upward, while neck pain and bruit gradually developed. She was diagnosed as aortitis syndrome from a digital subtraction angiography. The initial appearance of an ill-defined shadow on a chest roentgenogram, considered as pulmonary infarction, is rare in the aortitis syndrome and this kind of onset is interesting in relation to the pathogenesis and diagnosis of this syndrome.

Angiography, Digital Subtraction↗

SEGMENTAL AORTITIS AND AORTIC INCOMPETENCE.

An unusual case of a middle-aged male with segmental aortitis and aortic incompetence is described. To our knowledge, only 13 cases have been previously described in the literature, but only two have had anatomopathological confirmation. Aortic incompetence is a rare manifestation of segmental aortitis. Although intrinsic abnormalities of the aortic valve have been proposed, the finding of a normal aortic valve at postmortem examination in 2 of the 3 cases in which the aortic valve was examined, supports the premise that the incompetence is probably secondary to disproportionate dilatation of the aortic root.

Journal Article↗

Aortic root replacement with a freestyle stentless valve for aortitis syndrome with ascending aortic aneurysm and aortic regurgitation.

A 47-year-old woman who had been diagnosed as having aortitis syndrome underwent aortic root replacement for an ascending aortic aneurysm and aortic regurgitation. Because the patient has been treated with steroids for more than 20 years, a Freestyle stentless valve was used to avoid the risk of valve detachment. There were no complications observed during the postoperative course. Although long-term follow-up will be necessary to observe the valve durability, the Freestyle stentless valve seems to be useful for aortic root replacement in patients at high risk of valve detachment due to aortitis syndrome.

Aortic Aneurysm↗

[Four cases of aortic valve replacement in aortitis syndrome].

Four surgically treated cases of aortic valve regurgitation associated with the aortitis syndrome were reported. All patients were female and ranged in age from 38 to 51 years. In two cases, obstructive lesions of the aortic arch branch were seen in aortograms. Three patients had no inflammatory findings at the operation and one was operated on after improvement of inflammatory findings by steroid therapy. Aortic regurgitation was caused by annuloaortic ectasia, and aortic valve replacement was performed by the everting mattress suture method in all cases. One patient with stenosis of the left carotid artery, occlusion of the left subclavian artery, and hypertension died of extended cerebral damage due to suspected low flow cerebral perfusion during cardiopulmonary bypass. The other three patients are doing well 4 months to 11 years after surgery without paravalvular leakage. In cardiac surgery for the aortitis syndrome with an obstructive lesion of the aortic arch branch, deep hypothermic and high flow cardiopulmonary perfusion is required to prevent ischemic brain complications during surgery.

Adult↗

[A case of coronary artery bypass for bilateral coronary ostial stenosis in aortitis syndrome with occlusion of bilateral subclavian arteries].

A 52-year-old female with bilateral coronary ostial stenosis in aortitis syndrome underwent CABG. Vein grafts were used instead of arterial grafts, because of the occlusion of bilateral subclavian arteries. Proximal anastomosis of the grafts was performed after oval stomas larger than usual were created on the aortic wall to prevent late graft occlusion due to intimal proliferation of the aorta. On postoperative CAG, all grafts to RCA, LAD and Cx were patent. The patient left the hospital 3 weeks after surgery. We believe that CABG is preferable to the transaortic endarterectomy in the surgical treatment for coronary ostial stenosis associated with aortitis syndrome, because of the prevalence of technical difficulty and postoperative morbidity in the latter.

Aortic Arch Syndromes↗

Intravalvular implantation technique for a modified Bentall's procedure in aortitis syndrome.

Surgical treatments of aortic root involvement in aortitis syndrome are frequently complicated by valve detachment and pseudoaneurysmal formation during active inflammation. A 40-year-old woman with aortitis syndrome complicating the ascending aortic aneurysm, severe aortic regurgitation (AR), and left coronary ostial stenosis was successfully treated by aortic root replacement and concomitant coronary artery bypass grafting (CABG) during acute inflammation. We devised an intravalvular implantation between the fragile aortic annulus and Teflon felt to a modified Bentall's procedure, which prevented anastomotic leakage and pseudoaneurysmal formation in the late period.

Adult↗

[A case of aortitis syndrome].

A 57 years old woman was admitted for the investigation of anginal chest pain. Her coronary angiography didn't show any typical finding seen in the aortitis syndrome, but coronary sclerosis and stenosis seen in the usual atherosclerotic patients. The cerebral angiography was performed, too. The right vertebral artery, which was tortuous and dilated, was seen, but the other three cerebral vessels were not seen. These rare findings were reported in this report. We added the discussion about the relation between the aortitis syndrome and angina pectoris.

Angina Pectoris↗

[Right pulmonary artery obstruction and pulmonary hypertension secondary to aortitis syndrome].

A 56-year-old woman with aortic arch syndrome and finally right pulmonary artery obstruction secondary to Takayasu's aortitis was presented. She had had a history of visual disturbance and dizziness when she looked upward since 1983. On admission in July, 1984, aortography showed obstruction of the right innominate artery and of the left subclavian artery. Pulmonary arterial pressure, pulmonary perfusion and ventilation images seemed to be normal at that time. After discharge from our hospital, she began in 1987, to be aware of dyspnea on effort. Because of this symptom, she was admitted again in March, 1988. The pulmonary perfusion images showed complete lack of perfusion in the right lung, and arterial blood gas showed hypoxia with 62 mmHg in PaO2, 39 mmHg in PaCO2. Cardiac catheterization confirmed pulmonary hypertension with pulmonary artery pressure of 56/18 mmHg. In conclusion, pulmonary perfusion and ventilation scintigraphy proved to be the best way to clarify the nature of a lesion of the pulmonary artery in aortitis syndrome.

Adult↗

[A case of aortitis syndrome with left coronary ostial stenosis and aortic regurgitation treated by transaortic coronary endarterectomy and aortic valve replacement].

A case, 23-year-old female of aortitis syndrome with left coronary ostial stenosis and aortic regurgitation was reported. The coronary angiography showed critical stenosis of the left coronary ostium with intact main stem and its branches. The aortogram revealed aortic regurgitation of grade III, and multiple obstructive or stenotic lesions on the left common carotid artery, the origin of the left renal artery, the inferior mesenteric artery and the abdominal aorta. After improvement of inflammatory findings by steroid therapy during 2 months, transaortic coronary endarterectomy and aortic valve replacement with 21 mm Björk-Shiley valve were performed successfully. Postoperative course was uneventful. Coronary angiography performed at the 57th day after the operation showed complete removal of the left coronary ostial stenosis, and aortography showed no evidence of perivalvular leakage of the aortic valve prosthesis. The indication of transaortic coronary endarterectomy and the technique used to avoid aortic valve detachment which may be caused by recurrence of aortitis were discussed in this paper.

Adult↗

[Left coronary ostial stenosis in aortitis syndrome--patch mounted graft technique for proximal anastomosis].

Late restenosis or total occlusion of proximal aortic anastomosis frequently occurs due to intimal proliferation in aortitis CABG patients although successful early postoperatively. A Gore-Tex patch (diameter 20 mm) mounted grafts to LAD and CX with a single ostium was sutured in the inflammatory aorta to prevent late occlusion in a 40-year-old female patient. Postoperative CAG a month after showed a patent graft to LAD and improved exercise treadmill test. Graft to Cx occluded due to competed flow from LAD. No aneurysm was found in the proximal anastomosis. Tissue nonpermeable Gore-Tex mounted graft is considered to be suitable for CABG in aortitis patients with the high incidence of late occlusion.

Adult↗