Cardiovascular manifestations of tertiary syphilis infections are uncommon, but represent an important cause of mortality and morbidity. Syphilitic aortitis is characterized by aortic regurgitation, dilatation of ascending aorta and ostial coronary artery lesions.We report a case of 36 years old man admitted to our hospital for acute anterior ST segment elevation myocardial infarction complicated with cardiogenic shock (hypotension 75/50 mmHg). Transthoracic echocardiography revealed a dilated left ventricle with severe systolic dysfunction (ejection fraction = 25%), severe mitral regurgitation, moderate aortic regurgitation and mildly dilated ascending aorta. Coronary angiography showed a severe ostial lesion of left main coronary artery which was treated by urgent stent implantation and an intra-aortic contrapulsation balloon was implanted. Blood tests for syphilitic infection were positive. The patient was discharged with treatment including benzathine penicillin.In our case, we present an acute manifestation of a syphilitic ostial left main stenosis treated by primary percutaneous coronary intervention in acute myocardial infarction. Long term follow-up of the patient is crucial as a result of potential rapid in-stent restenosis caused by continuous infection of the ascending aorta.This case is particular because it shows that syphilitic aortitis can be diagnosed in acute settings, like ST segment elevation myocardial infarction.
Background: Aortic coarctation (CoAo) may be discovered only when complicated by acute type A aortic dissection (ATAAD). We present a case with a one-stage repair of this pathologic association and review the relevant literature focusing on the surgical choices. Case report: A 43-year-old man presented with acute thoracic pain. Computed tomography and echocardiography demonstrated CoAo, ATAAD type II, an ascending aorta aneurysm, and moderate regurgitation of a bicuspid aortic valve. Emergency surgery was performed. A clamshell incision, cardiopulmonary bypass with dual arterial cannulation (axillo-femoral), CoAo repair (by resection-interposition), and supracoronary aorta replacement were performed. Four years later, the patient was healthy and asymptomatic. Review: Thirty surgical cases of ATAAD with CoAo repair after the dissection onset were included. Iatrogenic dissections and formerly repaired CoAo without surgical indication were excluded. Results: The mean patient age was 27.8 ± 12 years; there was a male predominance (76.7%). The patients frequently presented with ascending aorta aneurysm (86.2%), bicuspid aortic valve (69%), and type II dissection (79.3%); dissection never extended below the CoAo. The one-stage treatment (15 patients; 55.5%) included 12 surgical repairs of CoAo (mostly by ascending-to-descending aorta extra-anatomic bypass; 58.3%) and three balloon angioplasties. In patients with uncorrected CoAo at the onset of cardiopulmonary bypass, double arterial perfusion was used in 55.5%. Conclusions: One-stage repair (hybrid or surgical), double arterial perfusion, and extra-anatomic ascending-to-descending aorta bypass are the most common options for treating ATAAD-CoAo. The clamshell incision provides excellent access for an extended arch procedure and facilitates anatomic isthmus repair.
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