Coronary artery aneurysm associated with aortitis syndrome diagnosed pre- and intraoperatively

Aneurysm of the coronary artery associated with aortitis syndrome is extremely rare. This is a case report of a left coronary artery aneurysm associated with aortitis syndrome. The patient was a 47-year-old woman who complained of palpitation and dizziness on exertion. Aortogram revealed occlusion of the arch vessels, infrarenal aortic stenosis, and a fusiform aneurysm of the left coronary artery. There was neither an intraluminal thrombus nor occlusive changes in the coronary arteries. Severe systolic hypertension nearing 300 mmHg was present in the ascending aorta. Severe hypertension and direct extension of inflammation to the coronary artery seemed to be important factors for the formation of the aneurysm. To resolve the severe hypertension, a bypass operation between the ascending aorta and the abdominal aorta distal to the stenosis was performed. The postoperative course was uneventful and blood pressure was reduced.     

Mitral regurgitation associated with aortitis syndrome

Three patients with mitral regurgitation (MR) associated with aortitis syndrome are presented. All had multiple lesions of the large sized arteries, calcification of the aorta, mild inflammatory findings, a chronic course, and congestive heart failure. MR was observed by ventriculography in all 3 patients. Case 1 had mitral valve prolapse and secondary systemic hypertension. Case 2 showed mildly thickened mitral valve leaflets and had moderate aortic regurgitation (AR). Case 3 had massive AR. The grade of MR was moderate in Cases 1 and 2, and massive in Case 3. The left ventricle was moderately dilated in Cases 1 and 2 but contracted sufficiently and symmetrically in all 3 patients. Other than the prolapse, no significant mitral valve deformity or left ventricular asynergy was evident by ventriculography. The incidence of MR was 3.1% of 128 patients with aortitis syndrome observed in our clinic. MR may be found in the late stage of aortitis syndrome. It may be caused by a mild valvular lesion related to aortitis syndrome and be exacerbated by increased hemodynamic loads such as those which occur in secondary hypertension and AR.     

Pleural effusion associated with aortitis syndrome.

A patient with aortitis syndrome had a pleural effusion which subsided but reappeared with an exacerbation of aortitis symptoms while under antituberculosis treatment. The character of the fluid was that of an exudate, and the glucose concentration was normal. Clinical and laboratory features of the case suggest that the effusion was part of the aortitis syndrome per se.     

Aortic dissection associated with aortitis syndrome.

A 50-year-old woman with aortitis syndrome complicated by aortic dissection, is reported. The dissection was observed at the level of the descending thoracic aorta by aortography and at the intimal side of the dilated aorta on CT. An aneurysm of the right subclavian artery and a diffusely thick wall of the abdominal aorta were also observed. This case suggests that the uneven wall of the aorta in aortitis syndrome might be dissected at the intimal side by dilatation.     

Coronary artery disease screening in patients with diabetes

Coronary artery disease (CAD) is the most common cause of death in patients with diabetes. Many diabetics have asymptomatic CAD, and may benefit from early diagnosis. We review the recent literature to evaluate whether the current evidence supports screening for CAD in asymptomatic diabetics. Currently, no single screening modality has shown sufficient accuracy to determine which patients will have significant CAD. The combination of imaging modalities may show promise in improving the accuracy of screening, and limited data suggest that screening in this population may be associated with improved outcomes. However, based on the current evidence we presently do not recommend screening for CAD in this population.     

A case of coronary artery bypass grafting with right gastroepiploic artery for right coronary artery obstruction associated with aortitis syndrome

A case of a 66 year-old female with aortitis syndrome with right coronary arterial obstruction, was reported. The coronary arteriogram showed total occlusion of the right coronary artery (segment 2). On the aortogram, stenosis of the left common carotid artery, kinking and aneurysm of the descending thoracic aorta were revealed. Because she developed frequent attacks of effort angina and the descending thoracic aneurysm was small in diameter 38 mm, coronary bypass grafting to the right coronary artery was performed using the in situ right gastroepiploic artery. Postoperative course was not eventful and chest pain disappeared. In such cases, the right gastroepiploic artery is useful for coronary artery bypass grafting.     

Coronary artery obstruction associated with congenital aortic valve disease

Abnormal attachment of the aortic valve caused obstruction to left coronary arterial flow in a young girl, who presented with angina of effort. Aortic valve and root replacement resulted in the patient's effort tolerance returning to normal with resolution of the exercise electrocardiographic and angiographic abnormalities. This case emphasises the importance of an awareness of the existence of such defects and their amenability to surgical correction.     

Bilateral coronary ostial stenosis associated with aortitis syndrome

A patient with aortitis syndrome showed severe stenosis of the bilateral coronary ostium. We discuss the coronary angiographic findings and the treatment.     

Coronary artery disease in patients with congenital heart defects

The prognosis of patients with congenital heart defects has improved significantly: more and more patients reach adulthood and old age. At the same time, the possibility of cardiovascular morbidity increases. The conventional risk factors for coronary artery disease are at least as high or even higher in patients than in the general population. Obesity and sedentary life style are more common in adults with congenital heart defect (ACHD) than in general population. In some patients, for example those with coarctation of the aorta or patients with operated coronary arteries in the infancy, the incidence of coronary artery disease (CAD) is clearly increased. In some patients with cyanotic heart defects (e.g. Fontan), the incidence of CAD might be lower, but it usually returns to the average level or higher after correction of the defect. Coronary artery disease is one of the most important reasons for mortality also in ACHD patients, and the consequences of a coronary event might be more fateful in a patient with a corrected congenital heart defect than in her/his peer. There should be a paradigm shift from operative mortality and short‐term outcome to long‐term morbidity and prevention of cardiovascular disease – a task that often has been forgotten during follow‐up visits.     

Coronary artery stenosis in patients with valvular heart disease

144 patients with valvular heart disease (VHD) underwent selective coronary angiography. Significant coronary artery stenosis was found in 26% of the examined patients. Diagnostic accuracy of some clinical indexes was analysed in this group. Most useful in predicting the presence of significant coronary narrowing in patients with VHD were increased cholesterol level and the presence of arteriosclerosis in lower limbs. Patients over 40 years who have both these indicators should have coronary angiography performed prior to surgical treatment.