Case Report: Disappearance of Coronary Anastomotic Aneurysm by Steroid Therapy in Takayasu Arteritis: Pseudorepair of Pseudoaneurysm?

Abstract

Background: Takayasu arteritis (TA) is a large vessel vasculitis of unknown etiology characterized by chronic inflammatory changes of the aorta and its major branches. Complications such as anastomotic aneurysm and valve detachment have been reported in active TA patients who received aortic valve replacement and graft replacement of aorta.Case Summary:A 61-year-old man with a history of emergency aortic valve replacement and patch closure of the noncoronary sinus of Valsalva due to acute heart failure induced by acute aortic regurgitation and ruptured sinus of Valsalva 4 years ago was referred for exertional dyspnea. Dilatation of the sinus of Valsalva together with protrusion of the right sinus of Valsalva and ostial stenosis of the left coronary artery were newly found by computed tomography (CT). A Bentall operation with concomitant coronary artery bypass grafting was successfully performed with a composite graft. Diagnosis of TA was made on the basis of histological analyses of the resected sinus of Valsalva, though other arterial manifestations were not detected by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography. Three months later, a follow-up study revealed left coronary ostial pseudoaneurysm at the anastomotic site together with strong 18F-FDG uptake, leading to commencement of steroid therapy. Eight months later, disappearance of left coronary ostial pseudoaneurysm was found by a follow-up CT scan.Conclusion: This is a rare TA case in whom spontaneous resolution of coronary anastomotic aneurysm by steroid therapy was found without reconstructive surgery.

A case of aortic root replacement for annuloaortic ectasia due to Takayasu's arteritis in active inflammatory phase

“…Multiple reports detailing cases of delayed postoperative complications suggest reentry into the active inflammation phase of TA as an underlying cause. These include a case of delayed dehiscence 6 and a pseudoaneurysm in the coronary button following aortic root replacements, 7 with the authors of one report making the argument for lifelong monitoring of inflammation following surgery for some TA patients. 8 In the present case, pseudoaneurysm formation was not observed during follow-up because of the horizontal mattress sutures from the outside to the inside of the aortic root and appropriate inflammation control.…”

Immune-Mediated Non-Infectious Periaortitis After Aortic Graft Replacement Surgery: A Case Report Highlighting the Need for Immunosuppresive Therapy

“…Immunosuppressive treatment with glucocorticoid is suggested for the prevention of these complications [ 25 ]. There is also a report of successful resolution of anastomotic pseudoaneurysm developed after aortic graft replacement for aortic aneurysm due to Behçet’s aortitis with glucocorticoid treatment [ 26 ]. This observation suggested that immune-mediated inflammation can cause detachment of the implanted prosthetic valve or graft, or anastomotic aneurysm formation.…”