[Bilateral coronary ostial stenoses with aortic regurgitation in a patient with syphilitic aortitis].

Abstract

Syphilitic aortitis is now rare in developed countries and is sometimes overlooked. A 61-year-old man with bilateral coronary ostial stenoses (#5:90%, #1:99%) and Sellers III/IV aortic regugitatioin (AR) induced by syphilitic aortitis presented with chest pain. Preoperative rapid plasma reagin titer and Treponema pallidum hemagglutination test were strongly positive, 256 fold and 191.25 C.O.I., respectively. Aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) with bilateral internal thoracic arteries (ITA) was performed successfully. The angiographic features as follows: 1) coronary artery stenosis is generally limited to the ostia, 2) the grade of stenosis is almost always more than 90%, 3) AR is frequently associated with coronary ostial stenosis. CABG should be performed with ITA, not saphenous vein grafts, to avoid occlusion of the ostium of the saphenous vein graft by syphilitic aortitis. Retrograde cardioplegia should be performed if ostial stenosis is severe.

• Authors: H Tsukui, E Koh, S Yokoyama, M Ogawa, G Kato, H Saitoh
• Journal: Kyobu geka. The Japanese journal of thoracic surgery (Kyobu Geka) Vol. 56 Issue 2 Pg. 158-60 (Feb 2003) ISSN: 0021-5252 [Print] Japan
• PMID: 12635329 (Publication Type: Case Reports, English Abstract, Journal Article)

Topics

• Aortic Valve (surgery)
• Aortic Valve Insufficiency (etiology, surgery)
• Coronary Artery Bypass
• Coronary Stenosis (etiology, surgery)
• Heart Valve Prosthesis Implantation
• Humans
• Male
• Middle Aged
• Myocardial Revascularization (methods)
• Syphilis, Cardiovascular (complications, diagnosis, surgery)
• Thoracic Arteries (transplantation)
• Treatment Outcome