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PubMed2002

Fatal salmonella aortitis with mycotic aneurysm rupture.

Salmonellae most commonly cause uncomplicated cases of gastroenteritis but have a predilection for damaged blood vessels, especially those damaged by atherosclerosis. The abdominal aorta is most frequently affected. The most serious complication of aortitis is mycotic aneurysm formation with subsequent rupture. The authors present the case of a 61-year-old man who was found unresponsive at home 3 days after discharge from the hospital for treatment of gastroenteritis with bacteremia. Postmortem examination revealed a ruptured mycotic aneurysm with a large retroperitoneal hematoma. Numerous gram-negative rods were embedded in the wall of the aorta and surrounding inflammatory infiltrate, compatible with the patient's previously isolated. Whereas abdominal aortic aneurysm rupture is most commonly associated with atherosclerosis, the isolation of from blood cultures, coupled with radiographic evidence of gas surrounding the aorta, should raise the suspicion of infectious aortitis. Whereas fatal rupture of an aortic aneurysm secondary to atherosclerosis alone or in conjunction with aortitis will not have an impact on the manner of death, infections are reportable and thus have public health implications.

Aneurysm, Infected↗
PubMed1975

Pleural effusion associated with aortitis syndrome.

A patient with aortitis syndrome had a pleural effusion which subsided but reappeared with an exacerbation of aortitis symptoms while under antituberculosis treatment. The character of the fluid was that of an exudate, and the glucose concentration was normal. Clinical and laboratory features of the case suggest that the effusion was part of the aortitis syndrome per se.

Adult↗
PubMed1981

Dilatation of the aortic valve portion in aortitis syndrome. Angiographic evaluation of 70 patients.

The dilatation of the aortic valve portion was evaluated by angiography in 70 patients with aortitis syndrome (Takayasu's arteritis). The diameter at aortic valve commissure was 20 +/- 2.8 min/M2 (NS, vs control) in 46 patients without aortic insufficiency (AI), 23 +/- 2.0 (p less than 0.02, vs without AI) in 11 patients with AI (I or II in grade), 27 +/- 2.0 (p less than 0.01, vs I or II in grade) in 13 patients with AI (III or IV in grade). The diameter was 20 +/- 2.0 in 13 normal control cases and 20 +/- 4.0 in 6 patients with rheumatic AI. The diameters at the levels of aortic valve annulus, sinus of Valsalva and ascending aorta increased also significantly in the patients with AI secondary to aortitis syndrome. The diameter at aortic valve commissure in 24 patients with AI was correlated (r = -0.48, p less than 0.05) to the diastolic blood pressure. Any diameter at the aortic valve portion was not different significantly by the complication of systolic hypertension (greater than or equal to 180 mmHg) in both groups of cases with and without AI. These results indicated that the dilatation of the aortic valve portion was observed in the patient with AI secondary to aortitis syndrome and might be the primary and common cause of AI in all grades, and that the dilatation might not be accelerated by the associated hypertension.

Adult↗
PubMed1990

Coronary artery disease associated with aortitis syndrome in older patients.

Coronary artery disease associated with aortitis syndrome was studied in relation to the coronary artery lesions and age. Four (21%) of 19 patients with aortitis syndrome had coronary artery disease and the mean age of the 4 patients was 53 +/- 14 years. The coronary artery lesions included ostial stenosis in 2 patients and main branch stenosis in 2, but both types of lesion were isolated. The latter patients were older and had coronary lesions like arteriosclerosis on angiogram. Myocardial infarction and congestive heart failure were not present, but a severe coarctation of the aorta was observed in the latter. It was suggested that coronary artery disease might not be rare past middle age, and might include coronary ostial stenosis caused by aortitis and coronary main branch stenosis probably based on secondary arteriosclerosis whose onset was past middle age.

Adult↗
PubMed1991

Aortitis syndrome, coronary artery ectasia, and mid-ventricular obstruction.

A 46-year-old Japanese woman, who had been diagnosed as having aortitis syndrome 4 years earlier, was admitted to our hospital in May 1989. The diagnosis of aortitis syndrome was confirmed by intravenous digital subtraction angiography which showed stenotic lesions in each subclavian artery, the left common carotid artery, and the descending aorta. Coronary arteriography revealed diffuse and prominent dilatation of entire coronary artery segments. Moreover, a left ventriculogram showed complete obstruction of the mid-ventricle during systole. Thus, we diagnosed this case as aortitis syndrome complicated by coronary artery ectasia and mid-ventricular obstruction. The causal relations of these findings are discussed.

Adult↗
PubMed2001

[Aortitis syndrome associated with ulcerative colitis, preceded by pulmonary infarction involvement].

A 21-year-old woman with a 6-year history of ulcerative colitis admitted to our hospital with chest pain, cough and fever of unknown origin in August 1998. On admission, laboratory data showed positive inflammatory signs. A chest radiograph and chest computed tomogram (CT) revealed nodular shadows in the right upper lung field. Fifty days after admission, hypertension developed and a bruit was audible in the neck and the upper abdomen. Digital subtraction angiography showed stenosis in carotid, renal and right upper pulmonary arteries. On the basis of these results, a diagnosis of aortitis syndrome was made. Moreover, these findings indicated pulmonary infarction in the right upper lobe due to aortitis syndrome. Aortitis syndrome preceded by pulmonary infarction involvement is very rare. Autoimmune disorders may have been involved in this case because of the association with ulcerative colitis.

Adult↗
PubMed2003

[Bilateral coronary ostial stenoses with aortic regurgitation in a patient with syphilitic aortitis].

Syphilitic aortitis is now rare in developed countries and is sometimes overlooked. A 61-year-old man with bilateral coronary ostial stenoses (#5:90%, #1:99%) and Sellers III/IV aortic regugitatioin (AR) induced by syphilitic aortitis presented with chest pain. Preoperative rapid plasma reagin titer and Treponema pallidum hemagglutination test were strongly positive, 256 fold and 191.25 C.O.I., respectively. Aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) with bilateral internal thoracic arteries (ITA) was performed successfully. The angiographic features as follows: 1) coronary artery stenosis is generally limited to the ostia, 2) the grade of stenosis is almost always more than 90%, 3) AR is frequently associated with coronary ostial stenosis. CABG should be performed with ITA, not saphenous vein grafts, to avoid occlusion of the ostium of the saphenous vein graft by syphilitic aortitis. Retrograde cardioplegia should be performed if ostial stenosis is severe.

Aortic Valve↗
PubMed1965

SYPHILITIC AORTITIS: AUTOPSY EXPERIENCE AT THE OTTAWA GENERAL HOSPITAL SINCE 1950.

Twenty-six cases of syphilitic aortitis were found among 4173 autopsies performed at the Ottawa General Hospital since 1950. Although 10 aortic aneurysms, nine instances of coronary ostial stenosis and five examples of aortic incompetence were present in 20 cases, a clinical diagnosis of syphilitic aortitis had been established in only two patients. It is paradoxical that the clinical diagnosis of syphilitic aortitis is becoming less accurate as surgical techniques for the correction of its complications are being constantly improved.

Aortic Aneurysm↗
PubMed1992

[A successful surgical treatment of ascending aortic aneurysm, left common carotid artery aneurysm and left subclavian artery obstruction due to aortitis syndrome in active phase].

A 24-year-old female was admitted complaining of coldness of left upper extremity and pulsating tumor of the neck. She was diagnosed as ascending aortic aneurysm, left common carotid artery aneurysm and left subclavian artery obstruction due to aortitis syndrome on examinations. Although steroid treatment appeared to be effective in controlling inflammatory reaction, the left common carotid artery aneurysm increased in size and severe neck pain started. The risk of rupture was feared, and surgical intervention was carried out in spite of aortitis in active phase. The patient underwent surgery where aneurysmectomy and graft replacement for ascending aortic aneurysm, aneurysmectomy and graft replacement using autogenous saphenous vein for left common carotid artery aneurysm and bypass grafting for left subclavian artery obstruction were performed. The histology of resected specimens of aortic wall showed active aortitis. The postoperative course was uneventful and the patient was discharged on steroid.

Adult↗
PubMed2004

Predictors of left ventricular dysfunction in patients with Takayasu's or giant cell aortitis.

OBJECTIVES: The aim of this study was to determine the clinical and angiographic predictors of left ventricular systolic dysfunction (LVSD) from a relatively large and angiographically characterized Takayasu's or Giant Cell aortitis (TA/GCA) population. BACKGROUND: LVSD in patients with TA/GCA has been described in case reports and attributed variously to hemodynamic and immunologic factors. The predictors of LVSD in patients with angiographically confirmed TA/GCA are not known. METHODS: We identified 78 patients with angiographically confirmed TA/ GCA that underwent transthoracic echocardiography (TTE) at Mayo Clinic. Echocardiograms were then reviewed independently by reviewers blinded to clinical and angiographic data. LVSD was defined as an ejection fraction (LVEF) less than 50%. RESULTS: The study population was 84% Caucasian (54/78), 91% female (58/78), and had a mean age of disease onset of 30 years (+/- 15 years). LVSD was present in 14 of 78 patients (18%) with TA/GCA. The mean LVEF in the LVSD group (n = 14) was 37% +/- 7%, compared to an LVEF of 62% +/- 6% (p < 0.0001) in those without LVSD (n = 64). LVSD was not associated with hypertension or aortic regurgitation (p > 0.5). However, LVSD was found in 43% (9/21) of patients with aortic arch involvement, versus only 9% (5/57) of patients without aortic arch involvement (p = 0.0013). Patients with LVSD had a median of 2 (range 1-4) involved aortic segments compared to a median of 1 (range 1-4) among those without LVSD (p = 0.013). CONCLUSIONS: In TA/GCA aortitis, LVSD is associated with involvement of the aortic arch and with the greater extent of aortic involvement. The hemodynamic variables, aortic regurgitation and systemic hypertension, were not associated with LVSD, consistent with reports that cardiac inflammation is responsible for LVSD in a majority of cases. Ours is the first study to estimate an incidence of LVSD in patients with TA/GCA aortitis, which was 18%.

Adult↗
PubMed1992

[A case of surgery for annuloaortic ectasia and aortic regurgitation complicated by ulcerative colitis and aortitis syndrome].

We performed an operation for AAE and AR complicated by ulcerative colitis and aortitis syndrome. The patient was a 20-year-old male who had been treated for ulcerative colitis in our hospital since 1983, when he was 18 years old. In 1985, he was admitted to our hospital for treatment and evaluation of left heart failure. He was diagnosed as having AAE and AR due to aortitis syndrome, and steroid therapy was started. He developed heart failure, and surgery was indicated. At operation, before clamping the aorta we made a composite graft. The ascending aorta and aortic valve were replaced by the composite graft, and button-shaped coronary ostia were sutured directly into the graft. His postoperative course was uneventful and he was discharged. He is now maintained on steroid therapy for his aortitis syndrome.

Adult↗
PubMed2005

[Coronary artery bypass graftingin a patient with aortitis syndrome; report of a case].

We present a case of surgical treatment for a coronary lesion due to aortitis syndrome. A 41-year-old woman, suffering from aortitis syndrome and under prednisolone (PSL) therapy, underwent coronary artery bypass grafting (CABG). Surgical treatment was performed according to the aortic no-touch technique, but the patient showed a poor cardiac performance 5 days after the operation. This accident was resolved by increasing the PSL dose. Aortitis syndrome treated with PSL needs careful perioperative management besides an operative procedure.

Adult↗
PubMed2006

[Ascending aortic aneurysm following aortic valve replacement due to aortitis syndrome; report of a case].

A 60-year-old woman had previously undergone aortic valve replacement for aortic regurgitation. As the aortic wall was elastic hard, inflammatory change was suspected; therefore, we undertook a partial biopsy of the ascending aortic wall and the intraoperative pathological specimens were compatible with aortitis syndrome. As there was no active inflammatory change, she was diagnosed as inactive aortitis syndrome and steroid therapy was not applied. Seven years later, a follow-up computed tomography (CT) showed an ascending aortic aneurysm of 65 mm in diameter. Aortic root replacement was planned based on a clinical diagnosis of an aneurysm of the ascending aorta. The patient was discharged without complication 21 days after surgery. It is possible that an inactive stage of aortitis may lead to late dilatation of the ascending aorta; therefore, careful postoperative follow-up is necessary in such cases.

Aorta↗
PubMed1991

[A case of aortitis syndrome complicated with amyloidosis, type AA].

We recently saw a patient who had aortitis syndrome associated with secondary amyloidosis. To our knowledge, she is the fourth report of this complication occurring in aortitis syndrome. In November 1985, the patient, a 18 year-old woman, was admitted to our hospital because of a high fever, back pain, abdominal pain and general fatigue. On physical examination, bruit was audible on the abdomen, bilateral radial artery was weakly palpable. Angiography showed the stenosis of bilateral carotid artery, subclavian artery, renal artery and superior mesenteric artery. From the above findings, she was diagnosed aortitis syndrome, and treatment was begun with prednisolone. However, she developed recurrently a high fever, chest pain, abdominal pain and exertional dyspnea. Laboratory findings at the active stage revealed the marked elevation of leukocytes, erythrocyte sedimentation rate and C-reactive protein. On her clinical course, the number of circulating thrombocytes was paralleled with the activity of the disease. On June 1988, she developed suddenly a high fever and severe pain of abdomen. Pathological findings of her stomach showed the deposition of amyloid protein A. Laboratory findings depicted the marked increment of thrombocytes, beta-thromboglobulin and platelet factor 4. These results suggest that circulating thrombocytes may play a role in product ion of amyloid protein.

Adult↗
PubMed1991

[A case of left coronary ostial obstruction due to syphilitic aortitis].

Coronary ostial stenosis is a rare lesion, which is a complication of syphilitic aortitis, Takayasu's aortitis, aortic valve disease, and familial hypercholesterolemia. We present a case of left coronary ostial obstruction due to syphilitic aortitis. A 67 years old man was admitted to our hospital for evaluation of a ten year history of angina on exertion. On physical examination, the only abnormal finding was a grade 2/6 high-pitched diastolic murmur. Coronary risk factor was not detected from biochemical results, but both the TPHA and FTA-ABS test were positive. Treadmill stress test showed more than 2 mm ST segment depression associated with chest pain. Coronary angiography revealed complete obstruction of left coronary ostium with good collaterals from the right coronary artery. The coronary arterial tree was otherwise normal. Furthermore, aortagraphy showed a moderate degree of aortic regurgitation. From the examination of previous reports including our own case, we think that the angiographic features of syphilitic coronary ostial stenosis can be summarized as below. 1. Coronary artery stenosis is generally limited to the ostium. 2. The grade of stenosis almost always shows more than 90% stenosis, and sometimes bilateral coronary ostium can be affected. 3. Aortic regurgitation is frequently noted, associated with coronary ostial stenosis.

Aged↗
PubMed1985

[Ruptured cerebral aneurysm associated with aortitis syndrome: a case report].

In rare occasions, patients with aortitis syndrome have cerebral aneurysms and only seven cases have been reported so far. A case of aortitis syndrome complicated with basilar bifurcation aneurysm is reported. A 58-year-old woman, who had been hypertensive for 20 years and was diagnosed as pulseless disease 10 years ago, suddenly had severe headache and became unconscious on Feb. 17, 1983. Spinal tap performed 3 days after the onset demonstrated bloody cerebrospinal fluid. She was referred to our clinic 8 days following the ictus of subarachnoid hemorrhage. On admission, she was drowsy and had headache, neck stiffness, disorientation and left hemiparesis. Pulsation of the left common carotid and left radial artery was unpalpable. Angiography through the intraaortic catheter revealed occlusion of the left common and left subclavian arteries at their origin, confirming aortitis syndrome. Through the patent right vertebral artery, basilar artery was visualized and an aneurysm at the basilar bifurcation was noted. Seven cases reported in the literature were reviewed.

Aortic Arch Syndromes↗
PubMed1982

[Aneurysm of anterior communicating artery associated with aortitis syndrome--a treated case by aneurysmal neck clipping (author's transl)].

A rare case of the cerebral aneurysm associated with aortitis syndrome was reported. It seems to be the first case in which neck clipping was successfully performed for aneurysm of the anterior communicating artery. The patient was a 48-year-old female afflicted with pulseless disease. She was admitted to Iwate Central Hospital with severe headache, vomiting and unconsciousness on November 16, 1980. Her radial pulse was faint on the right side. The left carotid angiography revealed an aneurysm in the anterior communicating artery, and neck clipping of the aneurysm was performed 17 days after the onset. The right serial brachiocephalic arteriography revealed occlusion of the right brachiocephalic artery and the right common carotid artery. The serial aortography revealed stenosis of the left common carotid artery and the left vertebral artery. In the literature, 4 cases of those 7 cases associated with aortitis syndrome had aneurysms at the basilar bifurcation or basilar top. It seems to be the reason that the vertebral artery outlasts longer in aortitis syndrome. In our case, we can relate the aneurysmal formation of the anterior communicating artery to the hemodynamic overload of the left A1. General anesthesia in such cases was discussed.

Aortic Arch Syndromes↗
PubMed1984

[Aortocoronary bypass graft in coronary arterial stenosis with aortitis syndrome].

A 50-year old female who had aortitis syndrome with unstable angina due to severe coronary arterial narrowings is described. On the preoperative coronary arteriogram, 95% occlusion of the left anterior descending coronary artery (segment 6) and the left circumflex artery (segment 11), so-called "skip lesion" of aortitis syndrome, were revealed. The distal circumflex artery was well visualized through collateral vessels of the posterior descending branch of the right coronary artery. Therefore single aortocoronary bypass graft to the left anterior descending branch was done with good success. Postoperatively the patient has been completely free from anginal chest pain. Narrowing of the coronary artery due to aortitis syndrome is considered uncommon. Stenotic lesions have been reported to be limited mostly to the ostia and proximal segments of the coronary arteries, connecting to the aortic wall. Moreover, so-called "skip lesion" of the coronary artery as seen in this case is thought to be very rare.

Angina, Unstable↗