Cases reported "Aortitis"

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1/32. Tuberculous infection of the descending thoracic and abdominal aorta: case report and literature review.

    We report here a case of infrarenal aortic disruption and aortoduodenal fistula secondary to tuberculous aortitis in a 77-year-old man. From a review of experience with operative management of tuberculous infection of the descending thoracic and abdominal aorta reported in the English-language literature, including the current report, we found that operative repair was attempted in 26 patients with tuberculous aortitis of the abdominal (n = 16), thoracic (n = 8), and thoracoabdominal (n = 2) aorta. Six patients had emergent operations for massive hemoptysis (n = 2), aortoduodenal fistula (n = 2), or abdominal rupture (n = 2), with an associated 30-day mortality of 50%. Elective or semi-elective repair was undertaken in 20 patients, of whom 19 (95%) survived for at least 30 days. On the basis of limited experience with this rare entity, in situ graft replacement is an appropriate treatment of tuberculous aneurysms and pseudoaneurysms of the descending thoracic and abdominal aorta.
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2/32. 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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3/32. Unusual complications in an inflammatory abdominal aortic aneurysm.

    An unusual case of an inflammatory abdominal aortic aneurysm (IAAA) associated with coronary aneurysms and pathological fracture of the adjacent lumbar vertebrae. The associated coronary lesions in cases of IAAA are usually occlusions. In the present case, it was concluded that a possible cause of the coronary aneurysm was coronary arteritis and the etiology of the pathological fracture of the lumbar vertebrae was occlusion of the lumbar penetrating arteries due to vasculitis resulting in aseptic necrosis. Inflammatory AAA can be associated with aneurysms in addition to occlusive disease in systemic arteries. The preoperative evaluation of systemic arterial lesions and the function of systemic organs is essential.
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4/32. Ten years' experience of aortic aneurysm associated with systemic lupus erythematosus.

    BACKGROUND: aortic aneurysm is a rare but life-threatening cardiovascular complication in patients with systemic lupus erythematosus (SLE). The purpose of this study was to clarify the characteristic clinical features and the pathological mechanism of aneurysmal formation in these patients. methods: among 429 patients operated on for abdominal aortic aneurysm (AAA) during the past 10 years, five cases with SLE were treated surgically. Their clinical data were reviewed, and the resected aneurysmal wall of the five patients was also examined histologically. RESULTS: the mean age of the patients with SLE was 55 years, which was statistically younger than that of the other patients (mean 77 years, s.d. 7.9, p <0.05). They had received long-term corticosteroid therapy for the treatment of SLE for a mean of 23 years. Histologically, destruction of the medial elastic lamina was characteristic. Four patients had no complications in the postoperative follow-up period (mean 4 years), while the remaining patient died of rupture of a dissecting aneurysm two years after operation. CONCLUSION: prolonged steroid therapy may play a major role in accelerating atherosclerosis, which can result in aortic aneurysmal enlargement, possibly together with primary aortic wall involvement and/or vasculitic damage in patients with SLE.
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5/32. Stanford type A aortic dissection in a hypertensive patient with atherosclerosis of aorta and aortitis.

    dissection of aorta is a serious condition; the main factors are hypertension and diseases of the connective tissue or of collagen. aortitis syndrome in combination with hypertension and atherosclerosis in association with ascending aortic dissection is rarely seen. We present the case of a 53-year-old hypertensive patient whose ascending aortic dissection was associated with pericardial effusion without rupture of the aorta and with pleural effusion. Several unusual aspects of transesophageal echocardiography are described. The intraoperative biopsy revealed inflammatory aortitis with mural hematoma, without giant cells. The literature concerning aortic dissection and aortitis is reviewed.
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6/32. A case of an ascending aortic aneurysm due to mesoaortitis complicated with idiopathic thrombocytopenic purpura.

    An 80-year-old man was referred to our hospital for the surgical treatment of an ascending aortic aneurysm. The diagnosis of idiopathic thombocytonenic purpura was also made by hematological studies which included the examination of the aspirated bone marrow. Preoperative chest computed tomography showed an ascending aortic aneurysm with a maximum diameter of 80 mm. echocardiography demonstrated mild aortic regurgitation. The platelet count increased by intravenous administration of immunoglobulin. A prosthetic graft replacement of the ascending aorta and aortic valve repair were carried out with the aid of cardiopulmonary bypass, selective cerebral perfusion and hypothermic circulatory arrest. No difficulty was encountered in hemostasis and the postoperative course was uneventful. Histological examination of the aneurysmal wall showed chronic mesoaortitis with patchy destruction of musculo-elastic medial tissue and adventitial focal lymphocytic infiltrates that were similar to syphilitic mesoaortitis, although serological treponemal tests were all negative. Perioperative administration of gamma-globulin is useful to minimize the hemorrhagic complication in a patient undergoing cardiovascular surgery with idiopathic thrombocytopenic purpura.
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7/32. Inflammatory aortic aneurysm: a case report and review of literatures.

    A case of an uncommon variant of aortic aneurysm, inflammatory type, is reported. A 51-year-old Thai male presented with a pulsatile abdominal mass associated with pain. ultrasonography demonstrated infrarenal abdominal aortic aneurysm preoperatively and operative findings revealed dense fibrous tissue around the lesion. Serological tests for syphilis and bacteriological studies of aneurysm contents were all negative. Aneurysmorrhaphy was done, using Dacron straight graft, and two serious complications developed at six and two months interval: aortocolonic and aortoduodenal fistulae. However, the patient survived the three operations. Definite diagnosis of inflammatory aortic aneurysm was confirmed by typical pathological findings. Clinical presentations, operative and pathological findings were compared to previous literature.
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8/32. Caval and ureteral obstruction secondary to an inflammatory abdominal aortic aneurysm.

    Inflammatory abdominal aortic aneurysms (IAAA) represent 3% to 10% of all abdominal aortic aneurysms. Obstructive uropathy is a well-described feature of IAAAs, but venous complications are unusual secondary to IAAA. The authors report a patient presenting with acute renal failure and deep venous thrombosis secondary to an IAAA. We believe this represents the first case of an IAAA manifesting as combined inferior vena cava compression and associated obstructive uropathy. Successful operative repair was performed. With resolution of the retroperitoneal inflammation, long-term follow-up revealed spontaneous release of both ureteral and caval compression.
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9/32. Behcet's aortitis and aortic regurgitation: a report of two cases.

    Behcet's disease is a rare systemic vasculitis that may lead to neurologic complications and rare manifestations of aortitis and aortic regurgitation. We report 2 cases of Behcet's aortitis and aortic regurgitation. The first patient presented with acute stroke. Recognition of acute aortitis on echocardiography led to the diagnosis of vasculitis as the cause of the cerebral event. This case highlights the echocardiographic features of aortic root pathology from acute aortitis to subsequent aortic valve perforation. In both cases, severe aortic regurgitation necessitated aortic valve replacement. Both were complicated by valve dehiscence requiring reoperation, illustrating the postoperative morbidity in this inflammatory condition.
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10/32. Aortic bypass graft infection due to Aspergillus: report of a case and review.

    Aspergillus is a rare cause of aortic graft infection. A recent case is reported and a review of seven other cases described in the literature since 1966 is presented. Infections of both thoracic and abdominal aortic grafts have been reported. infection occurred from 5 weeks to 3 years after surgery. Underlying immunosuppressive disorders were not present. The most common presenting symptoms were back pain, fever, and embolic phenomena. Pseudoaneurysm of the vascular prosthesis with contiguous vertebral osteomyelitis was frequently seen. blood cultures were always negative. Laboratory findings were nonspecific. The diagnosis was not anticipated in any case. Aspergillus was isolated in culture of specimens of the vertebral bone, excised graft, or peripheral emboli. aspergillus fumigatus was the species most frequently isolated. infection may have occurred intraoperatively as a result of contamination with airborne fungal spores. Optimal treatment included early removal of the graft with extraanatomical bypass plus prolonged antifungal therapy. Delayed surgical intervention and medical therapy alone were associated with high mortality rates. Aspergillar vascular infection should be suspected in patients with aortic grafts who develop persistent back pain, fever, or arterial embolization, and whose blood cultures are sterile.
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