1/30. Syphilitic aortic regurgitation. An appraisal of surgical treatment.During the 10 years from 1964 to 1973, fifteen patients with severe syphilitic aortic regurgitation were treated surgically at the National heart Hospital. In thirteen the valve was replaced and in two it was repaired. In addition four had replacement of an aneurysmal ascending aorta with a Dacron graft and seven some form of plastic repair to the coronary ostia. Three patients died within 1 month of surgery and a further six during the follow-up period which varied from 1 to 55 months (mean 25-5). The six survivors have been followed-up for an average of 33 months. Factors contributing to this high mortality were analysed and it was found that the mean duration of effort dyspnoea was 22 months in the survivors compared with 48 months in those who had died. Similarly the average duration of nocturnal dyspnoea was 4 months in the survivors compared with a mean of 8 months in those who had died. Only six out of the fifteen patients had angina; this was present in two of the survivors and in four of the fatalities. The pulse pressure, heart size, and haemodynamic findings were similar in the two groups. The prognostic value of an elevated erythocyte sedimentation rate was also examined. It was concluded that preoperative investigations should include aortography, coronary arteriography, an assessment of left ventricular function, and whenever possible myocardial biopsy. These data were interpreted as suggesting that patients should be referred for surgery at an earlier stage in the disease--certainly before the onset of cardiac failure and--and that if this more aggresive attitude was adopted, as it has been in non-syphilitic cases of aortic valve disease, the present high mortality in this group would be reduced.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
2/30. Syphilitic aneurysm of the abdominal aorta.A case of syphilitic aneurysm of the abdominal aorta is described. This unusual finding may be misdiagnosed as "inflammatory" abdominal aortic aneurysm, another condition associated with an intense periaortic inflammatory reaction. The authors discuss the differential diagnostic problems and the surgical technique advisable in these cases.- - - - - - - - - - ranking = 6keywords = aneurysm (Clic here for more details about this article) |
3/30. Syphilitic abdominal aortic aneurysm.A case report of a syphilitic aortic aneurysm in a 37-year-old male, presenting as upper abdominal pain accompanied by a pulsatile abdominal mass, is discussed.- - - - - - - - - - ranking = 5keywords = aneurysm (Clic here for more details about this article) |
4/30. Syphilitic aneurysm: case report.Tertiary syphilis is a rare, slowly progressive inflammatory disease that becomes clinically visible years after initial infection. Although it can affect any organ in the body, it shows a predilection for the cardiovascular and nervous systems. Today, however, cardiovascular syphilis is a medical curiosity because the disease can successfully be treated with antibiotics in its early phase. We present a case of a 43-year-old male patient with a syphilitic aneurysm of the descendent aorta and our choice of treatment.- - - - - - - - - - ranking = 5keywords = aneurysm (Clic here for more details about this article) |
5/30. Combined open and endovascular repair of a syphilitic aortic aneurysm.The use of endovascular stent grafts in the repair of thoracic aortic aneurysms has provided an alternative means of treatment, particularly in the high-risk patient who may not tolerate conventional open repair. The combination of conventional surgery and endovascular repair may allow for successful treatment in patients with anatomy unsuitable for repair entirely by endovascular means alone. We present the case of a patient with a syphilitic thoracic aortic aneurysm involving the aortic arch and descending thoracic aorta. He underwent a staged repair with an elephant trunk reconstruction of the aortic arch followed by endovascular repair of the descending thoracic aorta. This is the first reported case of the repair of a syphilitic aneurysm by means of endovascular techniques.- - - - - - - - - - ranking = 7keywords = aneurysm (Clic here for more details about this article) |
6/30. Ascending aorta syphilitic aneurysm presenting as a dystrophic disease.A 37-year-old female originating from Central africa presented with cardiac failure, aortic insufficiency and aortic root dilatation of supposed dystrophic origin. Left coronary ostial dilatation and dense adhesions between the aorta and the pulmonary trunk at operation were the only unusual features. However, pathological examination evoked a syphilitic disease and serology confirmed luetic infection. The diagnosis and the therapeutic approach are discussed. Syphilitic aneurysms belong to the protohistory of vascular surgery, but, in the antibiotherapy era, tracking a syphilitic aneurysm is like fishing for coelacanth. When this pathology mimics a dystrophic aneurysm, diagnosis and therapeutic attitude becomes hazardous and justifies the present report.- - - - - - - - - - ranking = 7keywords = aneurysm (Clic here for more details about this article) |
7/30. Ruptured giant syphilitic aneurysm of the descending aorta in an octogenarian.syphilis can lead to saccular aneurysms of the thoracic aorta. Today syphilitic aortic aneurysms are rare. The average time from primary infections to the development of aortic aneurysms is 10 to 15 years. An 83-year-old man was admitted with a giant aneurysm of the descending thoracic aorta. The patient had first experienced subacute pain in the left hemithorax some weeks previously. Computer tomography scan detected an 11 x 11 cm aneurysm of the descending aorta. Serodiagnostic tests for syphilis were highly positive. Femoro-femoral bypass was initiated and a tube graft was interposed. The postoperative course was uneventful, the patient was discharged at the twentieth postoperative day. Histological examination of the aneurysmal wall showed typical syphilitic changes. Postoperatively, penicillin g was given for 6 months. Three years later the patient remains asymptomatic. Although extremely rare today, tertiary syphilis should be considered in the differential diagnosis of thoracic aneurysms. In selected octogenarians replacement of the descending aorta is possible.- - - - - - - - - - ranking = 11keywords = aneurysm (Clic here for more details about this article) |
8/30. Early sternal erosion and luetic aneurysms of thoracic aorta: report of 6 cases and analysis of cause-effect relationship.Six patients with luetic aneurysm of the ascending aorta eroding the sternum are presented. The erosion was an early and principal presentation and the site of erosion and location and morphology of aneurysm were identical in all six patients. The erosion mainly affected the right half of the manubrium and medial end of right clavicle. The aneurysms arose from the junction of the ascending and transverse arches of the thoracic aorta and had narrow opening close to the origin of the innominate artery. The identical presentation, aetiology, angiographic location and morphology, corroborated further at surgery, suggests that syphilitic aneurysms in this location have a strong tendency to cause early sternal erosion.- - - - - - - - - - ranking = 8keywords = aneurysm (Clic here for more details about this article) |
9/30. review of isolated ascending aortitis: differential diagnosis, including syphilitic, Takayasu's and giant cell aortitis.The image of tree-barking and proximal aortic root dilatation is firmly entrenched in the minds of practising pathologists as representing syphilis until proven otherwise. We discuss the differential diagnosis of syphilitic aortitis, Takayasu's disease, and giant cell aortitis, with a review of the literature and brief overview of other types of aortitis. As a starting point, we report a case of non-specific, or idiopathic, aortitis with aneurysm that was initially misdiagnosed as syphilitic aortitis. We then review the literature and emphasise the lack of histological data and histopathological criteria for the diagnosis of non-infectious aortitis and the implications for treatment in cases of isolated aortitis. Tree-barking is a non-specific finding in aortitis of any aetiology, and syphilitic aortitis in developed countries is rare. It is still unclear if there are histological features that separate Takayasu's disease and giant cell arteritis. In the majority of patients presenting with aortic root aneurysms, aortitis is an isolated finding not associated with autoimmune disease. Despite a plethora of literature, a histological classification of aortitis has yet to be attempted.- - - - - - - - - - ranking = 2keywords = aneurysm (Clic here for more details about this article) |
10/30. Angiographic differentiation of thoracic aneurysms and neoplasms.The distinction between nondissecting aneuryms of the thoracic aorta and thoracic neoplasms may be difficult. The aortographic findings associated with aneurysms may be subtle. However, when the aortogram is properly performed and interpreted and the findings correlated with the plain chest roentgenograms the distinction between aneurysms and neoplasms may be made consistently. The thoracic aortogram should be filmed in at least 2 projections and abdominal aortography and ultrasonography should be performed. With aneurysms the aortographic signs include widening (often slight) of the aortic lumen, thickening of the aortic wall, small ulcer-like collections of contrast and non-filling of regional intercostal arteries. With neoplasms none of these radiological features is to be anticipated, while the aorta will be normal, displaced or narrowed.- - - - - - - - - - ranking = 7keywords = aneurysm (Clic here for more details about this article) |
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