Syphilitic aortitis: chronic left coronary ostial occlusion and aortic regurgitation with aortitis
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CASE REPORT
Syphilitic aortitis: chronic left coronary ostial occlusion and aortic regurgitation with aortitis Ryota Nomura1 · Fumio Yamazaki1 · Yuki Egawa2 Received: 26 August 2020 / Accepted: 12 October 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Before the discovery of penicillin, tertiary syphilis was the most common cause of thoracic aneurysms, but now cardiovascular syphilis is a clinical rarity in developed countries. We report a case of 69-year-old man who presented with sudden onset breathlessness that worsened insidiously for 2 months. Diagnosis of syphilitic aortitis was confirmed by laboratory findings, contrast computed tomography, echocardiography and coronary angiography. The patient underwent successful coronary artery bypass graft, aortic valve replacement and ascending aortic replacement. A high level of suspicion and awareness is needed for the diagnosis of the now rare disease. Keywords Syphilitic aortitis · Coronary ostial occlusion · Aortic regurgitation
Introduction There has been a dramatic decline in the morbidity and mortality of late syphilis since the advent of penicillin, cases of cardiovascular syphilis are still present even in developed countries. Described herein is a case of chronic left coronary ostial occlusion and severe aortic regurgitation with severe inflammation changes of the aorta, which was not initially suspected of a cardiovascular syphilis.
Case A 69-year-old male with hypertension, diabetes mellitus and active tobacco smoking presented with sudden onset breathlessness. Echocardiography showed severe aortic regurgitation (Fig. 1). Coronary angiography demonstrated complete obstruction of the left coronary ostium with good collaterals from the right coronary artery (RCA) (Fig. 2). Computed tomography scan showed prominent irregular thickening * Ryota Nomura [email protected] 1
Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, 10‑93 Otemachi, Aoi‑ku, Shizuoka 420‑8630, Japan
Department of Pathology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
2
of the aortic wall without aneurysm, suspected of severe atherosclerosis or inflammation change of the aortic wall (Fig. 3). On laboratory findings, C-reactive protein (CRP) and white blood cell count were slightly elevated, and rapid plasma regain card test (RPR) and Treponema pallidum Hemagglutination antibody test (TPHA) were both positive. After antibiotic therapy for active syphilis with intravenous benzathine penicillin G (BPG) for two weeks, surgery was performed through a midline sternotomy. Cardiopulmonary bypass was established with single arterial cannulation via the right femoral artery and venous drainage through the right atrium. Firm adhesion was found on maneuvering the ascending aorta, and aortic wall thickening and extensive intimal calcific deposits were confirmed after the incision of the aorta. All aortic cusps were hypertrophied with commissural fenestrations (Fig. 4). Ascending aortic replacement was performed under deep hypothermic
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