Giant Syphilitic Ascending Aortic Anuerysm

Case Presentation

Ann Surg Perioper Care. 2016; 1(3): 1017.

Giant Syphilitic Ascending Aortic Anuerysm

Natraj Setty HS*, kumar V, Raghu TR, Kharge J, Geetha BK, Patil SS, Jadhav SK and Manjunath CN

Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India

*Corresponding author: Natraj Setty HS, Assistant Professor of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India

Received: November 17, 2016; Accepted: December 26, 2016; Published: December 28, 2016

Abstract

Aneurysms are usually defined as a localized dilation of an arterial segment greater that 50% its normal diameter. The occurrence and expansion of an aneurysm in a given segment of the artery involves local hemodynamic factors. Aneurysmal degeneration occurs more commonly in the aging population. Ascending aortic aneurysm is the second most common aortic aneurysm after abdominal aortic aneursyms. Most ascending aortic aneurysm is diagnosed in sixth or seventh decade of life. Patient with connective tissue disorder and bicuspid aortic valve are diagnosed earlier in life. Ascending aortic aneurysms can involve proximally from the aortic annulus and can extend distally till the innominate artery. They may compress or erode into the sternum and ribs, superior vena cava or airway. They can rupture or dissect involving the pericardium, aortic valve, or coronary arteries. We report a case of gross ascending aortic anuersym who presented with Dyspnoea NYHA class III and chest pain since six months. Options of surgery were discussed with patient’s relatives. But, the patient and her relatives were reluctant to give consent for surgery. Hence, Patient is on conservative management.

Keywords: Ascending aortic aneurysm; CT aortogram; 2D Echocardiography; Syphilis

Background

Aneurysms are usually defined as a localized dilation of an arterial segment greater that 50% its normal diameter. The occurrence and expansion of an aneurysm in a given segment of the artery involves local hemodynamic factors. Aneurysmal degeneration occurs more commonly in the aging population. The incidence of late manifestations of syphilis have declined almost to a rare entity since the era of antibiotics. Before the discovery of penicillin [1]. The primary lesion of cardiovascular syphilis is aortitis, an inflammatory response to the invasion of the aortic wall by the Treponema pallidum that evolves to obliterative endarteritis of the vasa vasorum and results in necrosis of the elastic fibers and connective tissue in the aortic media. The resulting weakening of the aortic wall will progress into the late vascular manifestations of syphilis. The ascending aorta is the segment most commonly affected (50%), followed by the arch (35%) and the descending aorta (15%). The rich lymphatic arrangement in the ascending aorta that may predispose greater mesoaortitis is believed to be the cause for larger involvement of this segment [2].

Indications for surgical treatment of ascending aortic aneurysms are based on size or growth rate and symptoms. Because the risk of rupture is proportional to the diameter of the aneurysm, aneurysmal size is the criterion for elective surgical repair. To repair an extensive aortic aneursym is a challenging task because it poses problems of bleeding, end organ ischemia, underlying disease and staged repairs.

We report a case of gross ascending aortic aneursym who is on medical management.

Case Presentation

We report a case of gross ascending aortic anuersym who presented with Dyspnoea NYHA class III and chest pain since six months. On examination, early diastolic murmur of grade 2 in Erbs area. Routine investigation was normal. VDRL and TPHA were positive. HIV and connective tissue profile was normal. Chest XRAY revealed Cardiomegaly and Ascending aorta aneursym (Figure 1). 2D Echocardiography apical four chamber view shows ascending aortic aneurysm. Parasternal long axis shows gross ascending aortic aneurysm (Figure 2A and 2B). CT Aortogram revealed proximal ascending aorta – 82 X 83 mm (AP x RL) and distal ascending aorta – 85x77 mm (AP x RL). Arch and descending thoracic aorta was normal (Figure 3A and 3B). Patient was advised surgical management but patient and their relatives did not give consent for surgery. Patient was managed conservatively with anti failure medications. Patient improved symptomatically.