Asunto(s)
Insuficiencia de la Válvula Aórtica/historia , Fitoterapia/historia , Preparaciones de Plantas/historia , Sífilis Cardiovascular/historia , Insuficiencia de la Válvula Aórtica/diagnóstico , Insuficiencia de la Válvula Aórtica/tratamiento farmacológico , Insuficiencia de la Válvula Aórtica/fisiopatología , Digitalis/química , Historia del Siglo XVII , Historia del Siglo XVIII , Humanos , Literatura Moderna/historia , Preparaciones de Plantas/uso terapéutico , Plantas Medicinales/química , Sífilis Cardiovascular/diagnóstico , Sífilis Cardiovascular/tratamiento farmacológico , Sífilis Cardiovascular/fisiopatologíaAsunto(s)
Insuficiencia de la Válvula Aórtica , Insuficiencia Cardíaca , Penicilina G/administración & dosificación , Sífilis Cardiovascular , Treponema pallidum/aislamiento & purificación , Procedimientos Quirúrgicos Vasculares/métodos , Adulto , Antibacterianos/administración & dosificación , Insuficiencia de la Válvula Aórtica/diagnóstico , Insuficiencia de la Válvula Aórtica/etiología , Insuficiencia de la Válvula Aórtica/fisiopatología , Insuficiencia de la Válvula Aórtica/cirugía , Recuento de Linfocito CD4/métodos , Coinfección , Ecocardiografía/métodos , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Minorías Sexuales y de Género , Sífilis Cardiovascular/complicaciones , Sífilis Cardiovascular/diagnóstico , Sífilis Cardiovascular/fisiopatología , Sífilis Cardiovascular/cirugía , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
INTRODUCTION: Aortitis is a well-recognized manifestation of the tertiary stage of syphilis. EVIDENCE ACQUISITION: Although often regarded as an unexpected diagnosis, actually new cases of cardiovascular syphilis continue to be reported. Presumably, Treponema pallidum invades the aortic wall and the inflammatory response progresses towards obliterative endarteritis and necrosis of the muscular and elastic fibers in the aortic media. The consequent weakening of the aortic wall can lead to severe complications, represented by aortic aneurysm, aortic valvular insufficiency, aortic root dilation and coronary ostial stenosis. We perused the literature of the last 6 years to assess the prevalence and possible changes over time of syphilis cardiovascular manifestations. EVIDENCE SYNTHESIS: Forty four articles were collected, reporting on 66 patients. Many patients presented more than one complication. Aortic aneurysm was the most frequent involvement, detected in 71% of patients. Fusiform or saccular aneurysms often interested the thoracic aorta, primarily located on the ascending segment. The second most common complication was the aortic valvular insufficiency, found in 47% of patients. Coronary ostial stenosis and dilation of the aortic root were less frequent. CONCLUSIONS: Comparing our study with the previous ones, the cardiovascular involvement appeared roughly constant over time. Although many articles fail to provide useful information, such as a detailed history and the presence of risk factors, we must note that most patients had no predisposing factors and denied a primary infection. Cardiovascular syphilis is still present nowadays and it is important not to forget the "great imitator" in the event of its characteristic symptoms.
Asunto(s)
Aorta/fisiopatología , Sífilis Cardiovascular/fisiopatología , Aneurisma de la Aorta/etiología , Insuficiencia de la Válvula Aórtica/etiología , Estenosis Coronaria/etiología , Humanos , Sífilis Cardiovascular/complicaciones , Sífilis Cardiovascular/diagnósticoRESUMEN
Electrocardiographic voltage has been used to determine the presence of left ventricular hypertrophy for about 70 years. Varying electrocardiographic criteria have been applied. We have found total 12-lead QRS voltage to be most useful in this regard. We measured total 12-lead QRS voltage in 24 patients in whom an ascending aortic aneurysm was resected and histologic study of its wall was classic of syphilitic aortitis. In these 24 patients total 12-lead QRS voltage ranged from 57 to 161 mm, averaging 120 ± 32 in the 11 men and 106 ± 24 mm in the 13 women. If normal 12-lead QRS voltage in adults is considered to be >175 mm not a single one of the 24 patients had normal voltage. Indeed, most were in the low normal area. Thus, this study provides some evidence via this indirect means that the heart itself is infrequently involved by syphilitic aortitis which produces an ascending aortic aneurysm of sufficient size to warrant resection.
Asunto(s)
Aneurisma Infectado/fisiopatología , Aneurisma de la Aorta Torácica/fisiopatología , Aortitis/fisiopatología , Electrocardiografía , Sífilis Cardiovascular/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Aneurisma Infectado/cirugía , Aneurisma de la Aorta Torácica/cirugía , Aortitis/cirugía , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sífilis Cardiovascular/cirugíaRESUMEN
We present a 52-year-old male with a syphilitic aortic arch aneurysm accompanied by relevant extensive cerebral infarction. He was admitted to a local hospital for sudden loss of consciousness, where he was diagnosed with serious cerebral infarction. During his treatment, a multilocular aortic arch aneurysm involving the arch vessels was found incidentally. He was transferred to our hospital for surgical treatment. A preoperative routine laboratory test for syphilis was highly positive, which suggested that the aneurysm was likely caused by syphilis and the cerebral infarction was also induced by the involvement of syphilitic aortitis or arteritis. After 2 weeks of antibiotic therapy for syphilis, total arch replacement was performed successfully using meticulous brain protection with antegrade selective cerebral perfusion and deep hypothermia. He recovered without any further cerebral deficits. The pathological examination of the surgical specimen showed some characteristic changes of syphilitic aortitis.
Asunto(s)
Aneurisma Infectado/cirugía , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular , Infarto Cerebral/terapia , Sífilis Cardiovascular/cirugía , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiología , Aneurisma Infectado/fisiopatología , Antibacterianos/uso terapéutico , Aneurisma de la Aorta Torácica/diagnóstico , Aneurisma de la Aorta Torácica/microbiología , Aneurisma de la Aorta Torácica/fisiopatología , Aortografía/métodos , Biopsia , Infarto Cerebral/diagnóstico , Infarto Cerebral/microbiología , Infarto Cerebral/fisiopatología , Circulación Cerebrovascular , Paro Circulatorio Inducido por Hipotermia Profunda , Humanos , Hallazgos Incidentales , Masculino , Persona de Mediana Edad , Perfusión/métodos , Sífilis Cardiovascular/diagnóstico , Sífilis Cardiovascular/microbiología , Sífilis Cardiovascular/fisiopatología , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Insuficiencia de la Válvula Aórtica/etiología , Hipertrofia Ventricular Izquierda/etiología , Sífilis Cardiovascular/fisiopatología , Sífilis/fisiopatología , Anciano , Insuficiencia de la Válvula Aórtica/fisiopatología , Cardiomegalia/etiología , Cardiomegalia/patología , Electrocardiografía , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Hipertrofia Ventricular Izquierda/patología , Masculino , Penicilinas/uso terapéutico , Sífilis/tratamiento farmacológico , Sífilis Cardiovascular/tratamiento farmacológicoRESUMEN
The aneurismatic aortic disease is one of the most frequent conditions challenging the vascular surgeon. It can be caused by atherosclerosis, vasculitis, trauma, infection or others. The treatment, even when elective, can be associated to high rates of morbid-mortality, related to the etiology, anatomic location and type of treatment. The authors describe the case of a patient with concomitant syphilitic aneurysms of the descending thoracic aorta, pararenal and aortic bifurcation. The diagnostic presumption was supported by clinical and epidemiology data (the patient was treated for a syphilitic saccular infrarenal aortic aneurysm 5 years before). The etiology was confirmed by the pathological studies of the surgical specimen.
Asunto(s)
Aneurisma Infectado/microbiología , Aneurisma de la Aorta Abdominal/microbiología , Aneurisma de la Aorta Torácica/microbiología , Sífilis Cardiovascular/fisiopatología , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/diagnóstico , Aneurisma de la Aorta Torácica/cirugía , Humanos , Masculino , Persona de Mediana Edad , Sífilis Cardiovascular/diagnóstico , Sífilis Cardiovascular/cirugíaRESUMEN
Austin Flint murmur is a mid-diastolic rumbling audible in subjects with severe aortic regurgitation. Several theories have been raised to explain mechanistically the nature of this particular phenomenon. We briefly review severe aortic regurgitation under the light of contemporary echocardiography in an illustrative case.
Asunto(s)
Insuficiencia de la Válvula Aórtica/fisiopatología , Soplos Cardíacos/fisiopatología , Adulto , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Ecocardiografía Doppler en Color , Soplos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Sífilis Cardiovascular/diagnóstico por imagen , Sífilis Cardiovascular/fisiopatologíaRESUMEN
Os autores relatam um caso de aneurisma sifilítico da aorta (ASA) que, após o advento da antibioticoterapia quando ministrada nos estádios iniciais da doença, é de pouca incidência. A presunção diagnóstica foi corroborada por aspectos clínico-epidemiológicos sugestivos, radiografia e tomografia computadorizada do tórax, sendo confirmado pelo anatomopatológico da peça cirúrgica.
Asunto(s)
Humanos , Penicilina G Benzatina , Sífilis Cardiovascular/diagnóstico , Sífilis Cardiovascular/fisiopatología , Sífilis Cardiovascular/terapia , Diagnóstico por Imagen , IncidenciaRESUMEN
A 54-year-old man underwent aortic valve replacement for syphilitic aortic regurgitation. Eight years later, he was admitted with sudden precordial discomfort and symptoms of superior vena caval obstruction. Ascending aortic dissection was diagnosed by echocardiography and computed tomography of the thorax. The patient succumbed rapidly after admission. Postmortem findings and histological features were compatible with syphilitic aortitis, without significant atherosclerosis. This case report adds to the sparse literature on aortic dissection complicating syphilitic aortitis, and illustrates that, at certain stages of the disease process, syphilitic aortitis can lead to such a degree of mechanical instability of the aortic wall as to predispose to dissection.