Total arch replacement via single upper hemisternotomy approach for aortic aneurysm in syphilis: Case report.

RATIONALE: Syphilitic aortic aneurysm is a relatively rare type of cardiovascular syphilis. A small number of patients with syphilitic aortic aneurysms will be accompanied by aortic regurgitation and coronary stenosis. Apart from aortic rupture or dissection, syphilitic aortic aneurysm often causes associated vascular disorders, including left common carotid artery, innominate artery, and celiac artery stenosis or obstruction. PATIENT CONCERNS: In this case, we observed left common carotid artery occlusion based on both ultrasound and intraoperative exploration. For patients with syphilitic aortic aneurysm, the first choice is still sufficient antibiotic therapy. The surgical indications include symptom relief and prevention of aortic rupture or sudden death. DIAGNOSES: Aortic valve insufficiency, aortic aneurysm, and syphilis. INTERVENTIONS: Aortic valve replacement, aneurysmectomy and total arch replacement combined with frozen elephant trunk implantation via single upper hemisternotomy approach. OUTCOMES: The patient did not suffer reventilation and reoperation. No transient or permanent neurological dysfunction was observed in this patient. And no acute renal failure occurred. The patient was discharged on 43 days after the operation. LESSONS SUBSECTIONS: The upper hemisternotomy has the advantages of faster postoperative recovery, shorter ventilation time, shorter intensive care unit stay, less blood transfusion, and less incisional pain compared with the full sternotomy, which is one of the reasons why we chose this procedure for this patient.

Surgery for Ascending Aortic Aneurysm and Aortic Valve Insufficiency in Conditions of Active Proceeding Syphilitic Aortitis and Valvulitis.

A syphilitic aortitis is a late cardiovascular lesion of tertiary syphilis that has become exceptionally rare in the antibiotic era but not eradicated completely. Syphilitic aortitis of ascending aorta complicates in ascending aortic aneurysm formation and aortic valve regurgitation, both requiring surgical treatment. After surgery, lifelong surveillance of the remainder of the aorta is recommended because of a priori supposed high incidence of delayed involvement of noninvolved aortic segments. A 3-year follow-up result of surgery of syphilitic ascending aortic aneurysm with aortic valve regurgitation in condition of active ongoing syphilitic aortitis and valvulitis is described with addressing the dimensions of remaining aortic segments. This case demonstrates that the dilatation of the remainder of the aorta does not occur during 3 years, at least when anti-syphilitic course of antibiotic is used just after operation without additional treatment during the follow-up period. A few reports on surgical treatment of syphilitic aneurysms of the ascending aorta are discussed.

Treatment of syphilitic aortitis with coronary artery bypass grafting and "open" stent placement.

Cardiovascular syphilis manifests many years after primary infection. Here, we report the successful treatment of a patient who developed syphilitic aortitis with bilateral coronary ostial stenosis and aortic insufficiency. The patient underwent right coronary artery bypass grafting, left main coronary ostial "open" stent placement, and mechanical aortic valve placement during open-heart surgery.

Tertiary Cardiovascular Syphilis Presenting as Aortic Regurgitation, Aortitis, Thrombus, and Coronary Artery Occlusion, Requiring Percutaneous Coronary Intervention.

BACKGROUND Heart failure is caused by coronary artery disease, valvular disease, and arrhythmias and is highly treatable with recent technology. However, the incidence of syphilis is increasing worldwide. This case report describes tertiary cardiovascular syphilis, accompanied by aortic regurgitation, syphilitic aortitis complicated by thrombus of the ascending aorta, and coronary artery occlusion, requiring percutaneous coronary artery intervention. CASE REPORT A 51-year-old Japanese man with no significant medical history was admitted to the hospital for worsening shortness of breath on exertion. On physical examination, there was no edema in either lower leg. Chest X-rays showed an enlarged heart and pulmonary congestion, and echocardiography showed a left ventricular ejection fraction of 18%, with full circumferential wall motion impairment. Heart failure was diagnosed, and the patient was found to have severe coronary artery disease and aortic regurgitation. He underwent percutaneous coronary intervention (PCI) for his coronary artery occlusion and was treated with medications for heart failure. Two months later, his condition improved, and PCI was performed for the revascularization of the remaining coronary artery. After PCI was completed, the patient was evaluated for vasculitis. The aortic wall lesion was likely a result of non-active syphilitic aortitis, and the results of serological tests of syphilis were positive. Therefore, we concluded that the diagnosis was cardiovascular syphilis. CONCLUSIONS This case report has highlighted the need for clinicians to be aware of the cardiovascular findings in syphilis, including syphilitic aortitis, particularly at this time, when the global incidence of syphilis is increasing.

Aneurisma aórtico e insuficiencia valvular severa por sífilis terciaria en paciente joven, una enfermedad desatendida / Aortic aneurysm and severe valvular insufficiency due to tertiary syphilis in a young patient, a neglected disease / Aneurisma da aorta e insuficiência valvular grave devido à sífilis terciária em um paciente jovem, uma doença negligenciada

La sífilis es causada por Treponema pallidum, es reconocida por la variedad de sus manifestaciones clínicas; compromete el sistema nervioso, tegumentario y cardiovascular. Las alteraciones cardiovasculares ocurren en 70% de los casos con sífilis no tratada, el 71% de las aortitis sifilíticas desarrollan aneurismas aórticos y la complicación más frecuente es la insuficiencia aórtica. El tratamiento va dirigido a la enfermedad subyacente, con manejo antibiótico para la sífilis terciaria y las complicaciones tromboembólicas y si requiere reparación quirúrgica. Presentamos un caso poco frecuente de un paciente diagnosticado de infección por el virus de la inmunodeficiencia humana y complicaciones cardiovasculares típicas de la sífilis terciaria, que precisó tratamiento médico y quirúrgico, que fue exitoso. Destacamos la pericia clínica de los profesionales de nuestra institución para diagnosticar e identificar las complicaciones cardiovasculares de la sífilis terciaria.

Syphilis is caused by Treponema pallidum and is recognized by the variety of its clinical manifestations; it involves the nervous, integumentary and cardiovascular systems. Cardiovascular alterations occur in 70% of cases with untreated syphilis, 71% of syphilitic aortitis develop aortic aneurysms and the most frequent complication is aortic insufficiency. Treatment is directed at the underlying disease, with antibiotic treatment for tertiary syphilis and thromboembolic complications and if necessary surgical repair. We present a rare case of a patient diagnosed with human immunodeficiency virus infection and cardiovascular complications typical of tertiary syphilis, who required medical and surgical treatment, which was successful. We highlight the clinical experience of our institution's professionals in the diagnosis and identification of cardiovascular complications of tertiary syphilis.

A sífilis é causada pelo Treponema pallidum e é reconhecida pela variedade de suas manifestações clínicas; ela afeta os sistemas nervoso, tegumentar e cardiovascular. As alterações cardiovasculares ocorrem em 70% dos casos de sífilis não tratada, 71% dos casos de aortite sifilítica desenvolvem aneurismas aórticos e a complicação mais frequente é a insuficiência aórtica. O tratamento é direcionado para a doença subjacente, com tratamento antibiótico para sífilis terciária e complicações tromboembólicas e, se necessário, reparo cirúrgico. Apresentamos um caso raro de um paciente diagnosticado com infecção pelo vírus da imunodeficiência humana e complicações cardiovasculares típicas da sífilis terciária, que precisou de tratamento médico e cirúrgico, que foi bem-sucedido. Apresentamos um caso raro de um paciente com diagnóstico de infecção pelo vírus da imunodeficiência humana e complicações cardiovasculares típicas da sífilis terciária, que necessitou de tratamento médico e cirúrgico, o qual foi bem-sucedido. Destacamos a experiência clínica dos profissionais de nossa instituição no diagnóstico e na identificação das complicações cardiovasculares da sífilis terciária.

[Emergency Operation for Impending Rupture of Syphilitic Aortic Aneurysm with Left Coronary Ostial Stenosis:Report of a Case].

Syphilis is known as a cause of syphilitic aortitis. Chronic inflammation leads to formation of syphilitic aneurysm which often is found at the ascending aorta. If the inflammation spreads to the aortic root, stenosis of coronary ostium or aortic valve regurgitation are caused. We report a case that impending rupture of syphilitic aneurysm at ascending aorta with stenosis of left coronary ostium. The patient is a 49 years old male, and his chief complaint was chest pain which gradually became stronger. Computed tomography (CT) identified a large ascending aneurysm with a maximum diameter of 66 mm. The serum rapid plasma regain( RPR) test and the fixed Treponema pallidum latex agglutination( TPLA) test were positive. We diagnosed impending rupture of aneurysm, and performed emergency ascending aorta replacement. The aortic aneurysm was strongly adherent to the surrounding tissues. Pathological findings showed mesaortitis, which was consistent with syphilitic aneurysm. We started oral administration of amoxicillin hydrate from postoperative day 8. The patient did well, and was discharged on postoperative day 18. During his hospitalization, we performed enhanced coronary CT, and found stenosis of left coronary ostium. But he had no symptoms, so he got percutaneous coronary intervention after his discharge. Now the number of patients of syphilis is increasing in Japan. So it is important to know its characteristics and proper treatment.

Combined Cardiovascular Syphilis and Aortic Valve Stenosis (Due to a Congenitally Unicuspid Valve).

Described herein is a 53-year-old man who underwent resection of a fusiform aneurysm of the ascending aorta, and excision of a congenitally malformed stenotic unicuspid aortic valve. Examination of the wall of the aortic aneurysm disclosed classic features of syphilis. Although some degree of pure aortic regurgitation is common in patients with aortic syphilis, the presence of associated aortic valve stenosis, such as occurred in this patient, has been mentioned in only 4 previous publications, none of which included morphologic examination of the ascending aorta or aortic valve.

[Chest pain and chronic heart failure as a manifestation of tertiary syphilis: clinical case].

In cardiological practice, there may be patients with chest pain and heart failure of a specific etiology, including an association with cardiovascular syphilis. This article describes a 49-year patient with chest pain, heart failure, and neurological symptoms associated with ongoing tertiary syphilis. The history included an antisyphilitic treatment 30 years before the current hospitalization. Further evaluation confirmed neuro- and cardiovascular syphilis with severe aortic regurgitation and syphilitic myocarditis. Tertiary syphilis is a rare but relevant challenge for various medical specialists, including cardiologists. This pathology requires increased medical alertness and interdisciplinary interaction for early diagnosis, effective and safe treatment, and improved prognosis.

Combined Cardiovascular Syphilis and Type A Acute Aortic Dissection.

The occurrence of acute aortic dissection with the initiating tear in the ascending aorta superimposed on cardiovascular syphilis is an exceedingly rare occurrence. Such was the case, however, in a recently seen patient who presented with typical features of acute dissection (type A). Operative repair yielded the entire ascending aorta to examine both grossly and histologically and classic features of both conditions were observed.

Cardiovascular syphilis treated with transcatheter aortic valve replacement.

Cardiovascular syphilis presented with concomitant aortic regurgitation (AR) and left coronary ostial stenosis is rare, usually treated with on-pump aortic valve replacement and coronary artery bypass graft. We report a critical case of AR and left coronary ostial stenosis due to cardiovascular syphilis treated with emergent salvage transcatheter aortic valve replacement and percutaneous coronary intervention.

Sudden death due to rupture of an aortic syphilitic aneurysm.

A 26-year-old man who suddenly collapsed and died was found at autopsy to have a ruptured aortic aneurysm which had the classic "tree bark" appearance of tertiary syphilis. Tracking of blood into the pericardial sac had resulted in sudden death from cardiac tamponade. Serological results were consistent with syphilis and HIV was excluded. Sudden death in a young HIV-negative man from the effects of syphilis is exceedingly rare nowadays.

Impending Aortic Rupture in a Patient with Syphilitic Aortitis.

We report the case of a 48-year-old man, admitted for atrial fibrillation with rapid heart rate and intense chest pain. A quick evaluation revealed a giant aortic aneurysm with severe aortic regurgitation and pericardial fluid without a trace of aortic dissection. Because of high suspicion of aortic rupture, an emergency surgery was planned, and a Bentall procedure was performed. On examination of the aortic wall revealing vertical wrinkling with a tree bark aspect, suspicion of syphilitic aortitis arose. The diagnosis was confirmed through postoperative serologic testing and histological examination. Histopathologic differential diagnosis, special treatment and follow-up are presented.

The Use of Intracranial Vessel Wall Magnetic Resonance Imaging to Detect a Presumptive Syphilitic Brain Aneurysm.

ABSTRACT: Syphilitic intracranial aneurysm is a rare presentation of meningovascular syphilis in developed countries. In this case report, we discuss the utilization of the intracranial vessel wall magnetic resonance imaging in the management of a patient with a rare fusiform brain aneurysm, positive syphilis serologies, and inconclusive cerebrospinal fluid findings.

Cardiovascular syphilis-associated acute myocardial infarction: A case report.

RATIONALE: In recent decades, the incidence of advanced syphilis has declined due to early recognition and the application of effective antibiotics. Advanced syphilis often manifests in the cardiovascular system as simple aortitis, aortic valve insufficiency, coronary artery stenosis or obstruction, Aortic aneurysm and mucinous myocarditis. In most case reports on the subject, acute myocardial infarction caused by syphilis was reported to be due to aortic valve insufficiency and coronary stenosis as a result of the involvement of the aorta. PATIENT CONCERNS: The patient was a 48-year-old woman. She was admitted to our hospital because of intermittent upper abdominal pain with chest tightness for 3 hours. The patient reported a past syphilis infection, when she was hospitalized for hysteromyoma surgery four years ago, and had no related treatment. DIAGNOSIS: According to the characteristics of coronary angiography and results of lab tests and echocardiography, she was finally diagnosed with myocardial infarction associated with syphilis. INTERVENTIONS: At the first diagnosis of syphilis, the patient did not received antibiotics treatment. After the diagnosis of myocardial infarction, she received the percutaneous coronary intervention (PCI) operation assisted by extracorporeal membrane oxygenation (ECMO) technology, successfully got drug -eluted stents in right coronary artery ostium and left main ostium. Then the patient received penicillin to treat the syphilis infection. OUTCOMES: After coronary revascularization, the cardiac function of the patients was gradually improved, and the left ventricular ejection fraction was gradually improved after combined with optimized drug therapy. LESSONS: The cardiovascular system is often involved in the stages of advanced syphilis with severe complications like myocardial infarction. Standard treatment should be given as soon as syphilis is diagnosis. For stenosis of coronary ostium, the PCI assisted by ECMO technology did not only ensure the effectiveness of the treatment, but also reduce the surgical risk of the patient. This case indicated the effectiveness of ECMO-assisted PCI, and thus may provide a reference for future patient treatment.

Syphilitic aortitis: chronic left coronary ostial occlusion and aortic regurgitation with aortitis.

Before the discovery of penicillin, tertiary syphilis was the most common cause of thoracic aneurysms, but now cardiovascular syphilis is a clinical rarity in developed countries. We report a case of 69-year-old man who presented with sudden onset breathlessness that worsened insidiously for 2 months. Diagnosis of syphilitic aortitis was confirmed by laboratory findings, contrast computed tomography, echocardiography and coronary angiography. The patient underwent successful coronary artery bypass graft, aortic valve replacement and ascending aortic replacement. A high level of suspicion and awareness is needed for the diagnosis of the now rare disease.

Contained rupture of an aortic arch aneurysm in a patient with syphilitic aortitis. A case report / Ruptura contida de um aneurisma do arco aórtico em paciente com aortite sifilítica. Um relato de caso

Abstract Syphilitic aortitis is a rare complication of tertiary syphilis, which can lead to aortic aneurysm formation, aortic valvular insufficiency, and ostial coronary stenosis. Syphilis has re-emerged worldwide over recent decades and vascular surgeons should be aware of its cardiovascular manifestations. Atypical clinical presentation, such as hemoptysis and a computed tomography angiography pattern of a thicker aneurysmal wall with ulcer-like aneurysm projections, should raise suspicion of syphilitic aortic aneurysm. An early diagnosis and appropriate surgical and medical therapies significantly contribute to successful treatment and favorable prognosis. Herein is reported the case of an 82-year-old male patient, positive for syphilis infection, with impending aortic arch aneurysm rupture treated with a hybrid arch repair. After 7 months, the patient was brought to the emergency room in cardiac arrest. Unsuccessful cardiopulmonary resuscitation maneuvers were performed, and an autopsy showed cardiac tamponade due to rupture of the ascending aorta.

Resumo A aortite sifilítica é uma complicação rara da sífilis terciária, que pode levar a formação de aneurisma aórtico, insuficiência valvar aórtica e estenose ostial coronariana. Ao longo das últimas décadas, a sífilis ressurgiu ao redor do mundo, e os cirurgiões vasculares devem estar atentos às suas manifestações cardiovasculares. Apresentações clínicas atípicas, como a hemoptise, e um padrão na angiotomografia computadorizada de parede aneurismática mais grossa com projeções de aneurisma com aparência de úlcera devem levantar a suspeita de aneurisma sifilítico da aorta. O diagnóstico precoce e terapias cirúrgica e clínica adequadas contribuem significativamente para um tratamento bem-sucedido e prognóstico favorável. Relatamos o caso de um paciente do sexo masculino, de 82 anos, que apresentou infecção por sífilis com ruptura iminente de aneurisma do arco aórtico. Ele foi tratado com reparo híbrido do arco. Após 7 meses, o paciente deu entrada na emergência com parada cardiorrespiratória. As manobras de reanimação cardiopulmonar foram realizadas, mas não obtiveram sucesso, e a autópsia mostrou tamponamento cardíaco devido à ruptura da aorta ascendente.

[Hybrid Two-stage Repair of Syphilitic Aortic Aneurysm, Total Arch Replacement and Thoracic Endovascular Aortic Repair;Report of a Case].

Syphilitic aortic aneurysm is seldom seen in the antibiotic era. Statistically the number of patients is increasing today and 10% of them seem to develop syphilitic aortitis. A 59-year-old male visited the emergency room due to chest discomfort and general fatigue. Treponema pallidum latex agglutination (TPLA) and rapid plasma reagin (RPR) were both strongly positive on blood tests. White blood cell counts and C-reactive protein elevation were also found. He couldn't figure out how or when he was suffering from syphilis. He needed to undergo a hybrid 2-stage surgery urgently, Total arch replacement and thoracic endovascular aortic repair (TEVAR), because his thoracic aortic aneurysm was growing more rapidly. No complication has occurred during or after surgery. Computed tomography after surgery showed successful exclusion of the thoracic aneurysm. It is important not to forget that syphilis is one of the causes of aortic aneurysm.