Emergent thoracic aortic angioplasty and stenting for middle aortic syndrome in non-specific aortitis
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CASE REPORT
Emergent thoracic aortic angioplasty and stenting for middle aortic syndrome in non-specific aortitis Susumu Fujino • Tomohito Mabuchi • Shohei Yoshida • Masatomo Suzuki • Yoshihiro Noji • Masato Yamaguchi Takahiko Aoyama
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Received: 21 October 2009 / Accepted: 8 January 2010 / Published online: 19 February 2010 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2010
Abstract A 61-year-old Japanese male was admitted to hospital due to severe congestive heart failure and pre-renal failure with middle aortic syndrome. The patient was successfully treated with emergent aortic angioplasty and kissing stents implantation whilst in a hemodynamically unstable state. Our experience confirms that stenosis of the descending aorta when treated with catheter intervention may be palliative, however, it was a very effective method for life threatening clinical conditions in the short and midterm and may be an alternative to surgery. Keywords Takayasu’s arteritis Middle aortic syndrome Non-specific aortitis Aortic angioplasty Kissing stents
Introduction Middle aortic syndrome or mid-aortic dysplastic syndrome is a less common variety of aortic coarctation, characterized by segmental narrowing of the distal thoracic and abdominal aorta. In Japan, granulomatis vasculitis, which is commonly known as Takayasu’s disease or aortitis syndrome, is often concomitant with these types of aortic coarctation [1]. We present this case with involvement of the descending thoracic aorta and left subclavian artery treated with emergent aortic balloon angioplasty and stent implantation in a hemodynamically unstable state.
S. Fujino (&) T. Mabuchi S. Yoshida M. Suzuki Y. Noji M. Yamaguchi T. Aoyama Department of Cardiology, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui, Fukui 910-0846, Japan e-mail: [email protected]
Case presentation A 61-year-old Japanese male complaining of severe sudden onset dyspnea was admitted to the emergency room. There was no medical history of inflammation, fever and general fatigue. His atherosclerotic risk factors included arterial hypertension, dyslipidemia and diabetes mellitus that were identified at a routine health check by his company. In addition to these factors, he was a heavy cigarette smoker who smoked more than 2 packs per day for 40 years. However, he had not received any medical treatment up to the time he was admitted to hospital. A physical examination revealed diminished left radial and both femoral artery pulses. The blood pressure of the right upper limb was 200/120 mmHg and the pulse rate was 150 bpm. There was no precordial murmur but a systolic murmur in the right back area was detected. The chest X-ray revealed pulmonary edema with marked cardiomegaly. No abnormal collateral circulation was palpated. He was intubated for mechanical ventilation and treated with human atrial natriuretic peptide (‘‘HANP’’) infusion therapy and diuretics in the intensive care unit. He responded well to the HANP treatment, which resulted in the patient
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