Aortic root replacement for prosthetic aortic valve detachment without regurgitation and with englarged Valsalva’s sinuses and complete atrioventricular block caused by Takayasu’s aortitis

Abstract

We replaced the aortic root in a 43-year-old woman with Takayasu's aortitis associated with prosthetic aortic valve detachment. The patient's aortic valve had been replaced when she was 31 years old with a mechanical prosthesis to treat aortic regurgitation. Though C-reactive protein was kept almost normal with prednisolone, complete atrioventricular block suddenly appeared 12 years after the first operation. After the implantation of an artificial pacemaker, we closely followed up aortic root status. Aortography and echocardiography showed that the valve moved up and down, probably due to enlargement of the sinuses of Valsalva, without perivalvular leakage. We removed the prosthetic aortic valve, which was partially detached from the aortic valve ring at the right- and non-coronary cusps and successfully replaced the aortic root with a mechanical prosthesis inserted into a 26 mm woven graft. Although the postoperative course was uneventful, we closely continue to observe the case and to administer of antiinflammatory medication.

Aortic regurgitation and aortic valve operation in Takayasu arteritis: A meta-analysis

“…[12,14,15,20,23,24,28,[30][31][32]47] The degree of AR was not reported in 118 patients (74.2%). [10,16,18,22,26,35,38,45,50] In the remaining 41 patients (25.8%), one (2.4%) was mild, [29] nine (22.0%) were moderate, [11,12,23,34,37,41,42,49] one (2.4%) was moderate-to-severe [37] and 30 (73.2%) were severe [13][14][15]17,[19][20][21]24,25,27,28,[30][31][32][33]36,39,40,[42][43][44]…”

“…[48] In 33 patients (20.8%), the type of TA could be tracked: five (15.2%) were type 1, [28,33,34,37,47] 21 (63.6%) were type 2a, [11][12][13][14][17][18][19][20][21][22][23][24]27,29,30,36,38,39,46,48,49] one (3.0%) was type 2b, [31] three (9.1%) were type 3, [32,40,41] two (6.1%) were type 4, and one (3.0%) was type 5. [16] The activity of TA could be traced in 42 patients (26.4%): 37 (88.1%) were active [12,[14][15][16][18][19][20][21][22][23][24]26,28,[30][31][32]36,37,…”

“…[10][11][12]14,15,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][38][39][40]42,[44][45][46][47][48][49][50] The aortic valve operations that were performed in these patients were: aortic valve repair in three (2%) [12,30,32] (in one of them, aortic valve repair was performed after a three-week steroid treatment), [32] aortic valve replacement in 98 (65.3%), [10,11,14,17,18,20,[22][23][24][25]...…”

“…In the surgical patients, 16 patients (10.7%) received steroid therapy preoperatively, [13,15,26,31,32,34,42,49] and 19 patients (12.7%) received steroid therapy postoperatively. [13,15,26,31,32,34,42,49] Post-treatment ESR and CRP were reported for six [12,14,18,32,47,48] and four patients, [12,14,18,47] respectively.…”

Massive progression of annuloaortic ectasia in a patient with Takayasu aortitis

“…A few cases of cardiac conduction disturbance due to the extension of aortitis have been reported (3,4). Watanabe et al (3) and Yokoi et al (4) reported that the possibility of conductance disturbance was caused by a myocarditis-attributable disease.…”