Cases reported "Aortitis"

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1/35. A surgical case of atypical aortic coarctation using cardiopulmonary bypass.

    We report a 44-year-old woman with atypical aortic coarctation accompanied by cerebral artery disease. She was hospitalized for vertigo. An extra-anatomic bypass between the ascending aorta and abdominal aorta was performed using partial cardiopulmonary bypass under moderate hypothermia to reduce the after load of the left ventricle and maintain cerebral blood flow and cerebral perfusion pressure. The postoperative course was uneventful and there was no postoperative neurological deficiency.
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2/35. Management of inflammatory aneurysm of the infrarenal aorta using retroperitoneal exposure, open aneurysmorrhaphy and descending aorta-to-femoral artery bypass.

    The authors present a technique consisting of retroperitoneal exposure, but not dissection of the inflammatory aneurysm, anastomosis of a bypass graft through a short thoracotomy to the lowermost thoracic aorta, carrying it down retroperitoneally to both femoral arteries and under brief occlusion of the descending thoracic aorta, opening of the aneurysm and intra-aneurysmal occlusion of the inflow and outflow to the aneurysm. An illustrative case is presented.
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3/35. An unusual case of vegetative aortitis diagnosed by transesophageal echocardiography.

    We report a case of staphylococcus aureus aortitis in a 42-year-old man who had a fever, an embolus to the left upper arm, and positive blood cultures. Transesophageal echocardiography re-vealed a 3 x 1-centimeter polypoid mass attached to the intima of the medial wall of the aorta, just distal to the origin of the left subclavian artery. The clinical presentation and the transesophageal echocardiography findings led to the diagnosis of vegetative aortitis. Antibiotic therapy was begun, and 5 days later the mass was surgically excised to prevent the possible formation of an infective aortic aneurysm and embolization to the vital organs.
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4/35. Neonatal aortic arch thrombosis as a result of congenital cytomegalovirus infection.

    Thrombotic disease is rare in neonates. The main risk factors at this age are perinatal asphyxia, maternal diabetes, sepsis, polycythemia, dehydration, a low cardiac output, and in primis the catheterization of central lines. Another important risk factor is inherited thrombophilia. Arterial thrombosis is even more rare than venous thrombosis and less related to most of the risk factors listed above; it occurs more frequently in the iliac, femoral, and cerebral arteries but very rarely in the aorta. Most of the described cases of aortic thrombosis are associated with the catheterization of an umbilical artery and involve the descending tract and the renal arteries; very few relate to the ascending tract and the aortic arch. The possible role of virus-induced primary vascular endothelium damage in the etiopathogenesis of neonatal arterial thrombosis has been previously hypothesized. Herpesviruses, particularly human cytomegalovirus (HCMV), can infect endothelial cells and directly damage intact vascular endothelium, altering its thromboresistant surface as a result of procoagulant activity mediated by specific viral surface phospholipids, necessary for the coagulation enzyme complex assembly that leads to thrombin generation. We describe a case of congenital aortic arch thrombosis. The clinical, laboratory, and virologic pictures; the anatomopathologic findings (fully compatible with viral infection); the detection of HCMV in various tissues (including the aorta); and the absence of other causes of aortic thrombosis make it possible to attribute the case to a severe congenital HCMV infection with multiple organ involvement, after the primary infection of the mother. The hemostatic system disorders and hemodynamic disturbances related to viral cardiac damage explain the clinical features of the case and indicate that congenital HCMV infection should be included among the causes of neonatal aortic thrombosis.
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5/35. "Y" graft bypass for bilateral coronary ostial aortoarteritis.

    A case of bilateral coronary ostial aortoarteritis, which presented with angina pectoris, is reported. Emergency total arterial revascularization was performed using the bilateral mammary artery and radial artery, and the radial artery was hanged "Y" on the left internal mammary artery. The patient was discharged on low-dose steroid. He was asymptomatic at 1-year follow-up.
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6/35. Early venous coronary bypass graft occlusion in a patient with non-specific aortitis: a case report.

    A 58-year-old woman with aortic valve regurgitation and bilateral ostial coronary artery stenosis due to non-specific aortitis is presented. Four months after aortic valve surgery and venous bypass surgery, orificial occlusion or high grade stenosis of the bypass grafts occurred. Repeat coronary arteriography was followed by cardiac arrest and emergency surgery but patient did not survive. The etiology, pathological findings and surgical approach are discussed.
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7/35. Inflammatory aortic arch aneurysm with total occlusion of cervical branches.

    We surgically replaced the aortic root and the complex arch in a patient with aortitis syndrome with total occlusion of the cervical branches. Cerebral perfusion was being maintained through the reversed flow of the vertebral artery from the bilateral mammary arteries. Though cerebral perfusion was continued through the prosthetic grafts attached to the subclavian arteries during the procedure, bilateral watershed cerebral infarction corresponding to the most distal part of the anterior- and middle cerebral arterial system developed. With regard to the near infrared spectroscopy as a brain monitoring method, we sought to discuss the limitations.
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8/35. Accelerated atherosclerosis, aneurysmal disease, and aortitis: possible pathogenetic association with cocaine abuse.

    cocaine abuse and its association with vascular disease has become common in the medical literature. A variety of vascular problems have been described including neurovascular complications, cardiovascular complications, aortic dissection, venous thrombosis, mesenteric artery thrombosis, and renal infarction. The pathogenesis of these vascular complications has largely been related to increased adrenergic activity leading to vasospasm. Interaction of cocaine with the vascular endothelium resulting in thrombosis or vasculitis has also been suggested. We report a case of diffuse aneurysmal change of the aorta associated with an atypical inflammatory component consistent with possible cocaine induced vasculitis.
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9/35. hiv disease and an atherosclerotic ascending aortic aneurysm.

    Cardiovascular dysfunction appears to be an important complication of human immunodeficiency virus (hiv) infection and is being reported with greater frequency. There have been recent reports in the literature of hiv patients who suffer from vascular lesions such as large artery vasculopathy secondary to vasculitis, as well as accelerated atherosclerosis of the coronary arteries. The latter has been linked to patients on protease inhibitors that are used as part of a highly active antiretroviral therapy (HAART) regimen and have also been implicated in a lipodystrophy syndrome. We report a rare case of an hiv-infected patient on HAART who presented with a large ascending aortic aneurysm associated with symptomatic severe aortic regurgitation. A noteworthy finding on pathological analysis of the aorta was an etiology of accelerated atherosclerosis rather than the more expected vasculitis.
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10/35. HLA-B27 associated spondyloarthropathy, vasculitis, and amyloid enteropathy: response to infliximab.

    In 2000 we described a patient with HLA-B27 associated spondyloarthropathy (SpA) and severe ascending aortitis requiring surgical intervention. Despite continued immunosuppressive therapy she developed narrowing of the distal part of the right subclavian artery and proximal axillary artery secondary to active vasculitis. In addition, biopsy-proven amyloid gastroenteropathy developed causing persistent diarrhea and iron deficiency anemia. Treatment with infliximab resulted in resolution of joint symptoms and rapid improvement in laboratory markers of inflammation. diarrhea settled more gradually, such that her bowel habit had normalized 16 months after therapy commenced.
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