Annuloaortic Ectasia and Giant Cell Arteritis

Aortic Complications of Giant Cell Arteritis: A Diagnostic and Management Dilemma

“…In making the comparison, it should be remembered that surgical risk is likely to be comparatively higher in GCA than in Marfans syndrome for three reasons: the inflamed aorta provides a greater technical challenge potentially increasing graft complication rate, the requirement for ongoing immunosuppressive treatment increases infection risk and reduces healing rate, and the relatively older population is more likely to suffer from other complicating comorbidities. This teleological argument does not, however, correlate with the available literature on surgery for nondissecting giant cell aortitis, where early mortality ranges from 0% 15 to 10% 6 (Table 3). Contrastingly, early mortality in the series describing operative results for dissecting giant cell aortitis is 70% (Table 4), 22‐25 , an outcome drastically worse than the <25% operative mortality expected for all‐comers with aortic dissection 33 …”

“…In the situation of isolated aortic valve regurgitation, Gelsomino et al 6 reported two cases of primary aortic valve replacement for isolated valvular disease with macroscopically normal aortic roots that each required resternotomy and root replacement for subsequent aortic root dilatation. In their series of ten cases, all other patients had abnormal aortic roots and required root replacement as a part of the primary operation 6 . The authors subsequently recommended primary aortic root replacement in all cases of known GCA requiring open operative repair, but the evidence is not unanimous.…”

“…Unfortunately, such a strategy of routine root replacement also lacks pragmatic value in many cases simply because it requires such a preoperative diagnosis of GCA, an issue well exampled by all three case series. Preoperative diagnoses of GCA are reported in only 27% (including PMR), 15 20%, 6 and 0%, 3 respectively (Table 1). The strategy would be more easily applicable to aortic dissection; however, the combined case reports show a preoperative diagnosis of GCA in 59% (Table 4).…”

Komplikationen und Prognose der Polymyalgia rheumatica

“…Als Spätmanifestation einer Aortitis können auch Jahre nach Diagnosestellung thorakale Aortenaneursymata und -dissektionen auftreten, die dann mit einer erheblich erhöhten Mortalität einhergehen [ 21 , 23 ] . Mögliche Folgen der aneurysmatischen Aortendilatation bei Aortitis sind Aortenklappeninsuffi zienzen [ 27 ] . …”

Aortitis and aortic aneurysm in systemic vasculitis

“…More recently, other authors have investigated the prevalence of aortitis in specimens obtained from patients who underwent aortic reconstructive surgery because of aortic aneurysm, aortic dissection or aortic valve insufficiency. Table 2 summarizes the main findings of these studies (Burke et al, 2008;Gelsomino et al, 2005;Homme et al, 2006;Kerr et al, 2000;Liang et al, 2009;Miller et al, 2006;Nesi et al, 2009;Pacini et al, 2008;RojoLeyva et al, 2000). Histopathologic analysis of removed aortic fragments revealed chronic inflammation in about 1,7 to 8,7% of patients subjected to aortic surgery.…”