1/16. 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 = coronary (Clic here for more details about this article) |
2/16. Coronary bilateral ostial enlargement using the saphenous vein in a patient with syphilitic aortitis.A patient with tertiary syphilis presenting with bilateral coronary ostial lesions and aortic regurgitation underwent surgical reconstruction of the coronary ostia by the anterior approach with autogenous saphenous vein grafting and substitution of the aortic valve with a bovine bioprosthesis. The procedure was easily performed and had good outcomes both early and late. The rarity of the association of a lesion in both coronary ostia with aortic regurgitation in syphilis and the surgical technique employed are discussed.- - - - - - - - - - ranking = 1.5keywords = coronary (Clic here for more details about this article) |
3/16. Syphilitic aortitis.A case of syphilitic aortitis, complicated by bilateral coronary ostial stenosis, in a 40-year-old man is described. Treatment included coronary artery bypass grafting and a drug regimen of penicillin. At 3-month follow-up, an exercise stress test revealed no signs of ischemia.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
4/16. Accelerated atherosclerosis in tertiary syphilis and successful treatment with saphenous vein grafting--a case report.A 48-year-old male patient having none of the known risk factors for atherosclerosis underwent coronary artery bypass graft (CABG) surgery because of double-vessel coronary artery disease. During the operation, the aorta, both internal thoracic arteries (L/R-ITA), and the femoral artery were sclerotic, and CABG was performed using only saphenous vein grafts. A diagnosis of tertiary syphilis had been confirmed by either microscopic or serologic tests. There were different degrees of sclerosis in different arteries of different sizes. The presence of coronary artery disease with no known atherosclerotic risk factors should include preoperative testing for connective tissue disorders, chronic inflammatory disease, and cold hemagglutinins, because of the possible use of obligatory deep hypothermia or total circulatory arrest due to a diseased ascending aorta.- - - - - - - - - - ranking = 1.5keywords = coronary (Clic here for more details about this article) |
5/16. 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 = 0.5keywords = coronary (Clic here for more details about this article) |
6/16. Syphilitic coronary artery ostial stenosis resulting in acute myocardial infarction and death.cardiovascular abnormalities are well-known manifestations of tertiary syphilis infections. Most notable in this regard is syphilitic aortitis, which tends to result in aortic root dilatation and its associated complications. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. Herein, we present the case of a 32-year-old female who died of a myocardial infarct due to coronary artery ostial stenosis secondary to syphilitic aortitis.- - - - - - - - - - ranking = 3keywords = coronary (Clic here for more details about this article) |
7/16. Bilateral ostial coronary stenosis and rheumatic aortic valve stenosis.A 49-year-old patient presented with angina pectoris and clinical findings of aortic valve stenosis and regurgitation. Rheumatic aortic valve stenosis and regurgitation was diagnosed on echocardiography. coronary angiography findings showed severe calcification in the aorta root with right coronary ostial occlusion, and were suggestive of left main ostial stenosis and proximal main stem stenosis, which was confirmed on CT angiography. Curvilinear calcification of the aorta was present on CT angiography. The findings suggested syphilitic aortitis. syphilis serology was positive (RPR titre 1/16). The angina was caused by severe coronary ostial disease likely due to syphilitic aortitis and exacerbated by the rheumatic aortic valve stenosis and regurgitation.- - - - - - - - - - ranking = 3keywords = coronary (Clic here for more details about this article) |
8/16. Severe syphilitic aortic regurgitation with bilateral critical coronary ostial stenosis.A forty-year-old male with syphilitic severe aortic regurgitation and critical bilateral coronary ostial stenosis, proved by cardiac catheterization and angiocardiography, is presented. He underwent successful aortic valve replacement and coronary artery bypass grafting with gratifying results.- - - - - - - - - - ranking = 3keywords = coronary (Clic here for more details about this article) |
9/16. "Late" manifestations of cardiovascular syphilis occurring in a young man.A young man who presented with a short history of angina was found to have syphilitic coronary ostial stenosis six years after the primary infection. He was successfully treated with bilateral internal mammary grafts.- - - - - - - - - - ranking = 0.5keywords = coronary (Clic here for more details about this article) |
10/16. Recurrent myocardial infarctions secondary to luetic coronary arteritis in hypertrophic cardiomyopathy. A case report.A 43-year-old coloured man had no risk factors for atheromatous coronary artery disease but suffered two acute myocardial infarctions (MIs) in rapid succession. Serological reactions for previous syphilitic (luetic) infection were positive. Hypertrophic cardiomyopathy (HCM) without obstruction was verified, although right ventricular endomyocardial biopsy specimens did not demonstrate histological features of this disease. Extensive MI was verified on left ventricular cine angiography. Selective coronary arteriography showed that the coronary arterial tree was diffusely aneurysmal in the absence of any obstruction. We postulate that syphilitic coronary arteritis, in the absence of the more pathognomonic coronary ostial stenotic lesions, was present and may have predisposed to coronary thrombus formation and repeated acute MI. Recurrent coronary vasospasm, associated with the HCM, cannot be excluded with certainty.- - - - - - - - - - ranking = 5.5keywords = coronary (Clic here for more details about this article) |
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