Identifying Cardiovascular Syphilis at Operation

Roberts, William C.; Bose, Rahul; Ko, Jong Mi; Henry, Albert; Hamman, Baron L.

doi:10.1016/j.amjcard.2009.06.071

Cited by 24 publications

(9 citation statements)

References 20 publications

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“…The remaining 2 patients with tricuspid aortic valves had healed aortic dissection but neither patient had detectable loss of medial elastic fibers. Thus, among the patients with pure AR, the ascending aorta clearly needs to be replaced if the patient has the Marfan syndrome or a forme fruste variety of it, but probably not so if the dilatation of the ascending aorta is limited to its tabular portion in the setting of a tricuspid aortic valve and patients with aortitis (giant cell or syphilis 24 ) and acute dissection are excluded.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Structure of the Aortic Valve and Ascending Aorta in Adults Having Aortic Valve Replacement for Aortic Stenosis Versus for Pure Aortic Regurgitation and Resection of the Ascending Aorta for Aneurysm

et al. 2011

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Background-There is debate concerning whether an aneurysmal ascending aorta should be replaced when associated with a dysfunctioning aortic valve that is to be replaced. To examine this issue, we divided the patients by type of aortic valve dysfunction-either aortic stenosis (AS) or pure aortic regurgitation (AR)-something not previously undertaken. Methods and Results-Of 122 patients with ascending aortic aneurysm (unassociated with aortitis or acute dissection), the aortic valve was congenitally malformed (unicuspid or bicuspid) in 58 (98%) of the 59 AS patients, and in 38 (60%) of the 63 pure AR patients. Ascending aortic medial elastic fiber loss (EFL) (graded 0 to 4ϩ) was zero or 1ϩ in 53 (90%) of the AS patients, in 20 (53%) of the 38 AR patients with bicuspid valves, and in all 12 AR patients with tricuspid valves unassociated with the Marfan syndrome. An unadjusted analysis showed that, among the 96 patients with congenitally malformed valves, the 38 AR patients had a significantly higher likelihood of 2ϩ to 4ϩ EFL than the 58 AS patients (crude odds ratio: 8.78; 95% confidence interval: 2.95, 28.13). Conclusions-These data strongly suggest that the type of aortic valve dysfunction-AS versus pure AR-is very helpful in predicting loss of aortic medial elastic fibers in patients with ascending aortic aneurysms and aortic valve disease. (Circulation. 2011;123:896-903.)

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Section: Discussionmentioning

confidence: 99%

Comparison of the Structure of the Aortic Valve and Ascending Aorta in Adults Having Aortic Valve Replacement for Aortic Stenosis Versus for Pure Aortic Regurgitation and Resection of the Ascending Aorta for Aneurysm

et al. 2011

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“…(Am J Cardiol 2015;116:1298e1303) In 2009, we described finding in 22 patients who underwent operative resection of an ascending aortic aneurysm at the Baylor University Medical Center (BUMC) from 1998 to 2008, and histologic examination of the aneurysmal wall was typical of syphilitic aortitis. 1 The emphasis of that report was the describing of the morphologic features of syphilitic aortitis so that the condition could be more readily diagnosed at operation and also to emphasize that syphilis as a cause of thoracic aortic aneurysm had not disappeared. The present study was prompted by studying an additional 23 patients who underwent resection of an ascending aortic aneurysm caused by syphilitic aortitis at the same institution during the subsequent 6 years, again to emphasize that this condition has far from disappeared.…”

mentioning

confidence: 97%

“…1 The emphasis of that report was the describing of the morphologic features of syphilitic aortitis so that the condition could be more readily diagnosed at operation and also to emphasize that syphilis as a cause of thoracic aortic aneurysm had not disappeared. The present study was prompted by studying an additional 23 patients who underwent resection of an ascending aortic aneurysm caused by syphilitic aortitis at the same institution during the subsequent 6 years, again to emphasize that this condition has far from disappeared.…”

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confidence: 97%

Syphilis as a Cause of Thoracic Aortic Aneurysm

Roberts

Barbin

Weissenborn

et al. 2015

The American Journal of Cardiology

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“…The pathological results of our case were compatible with these findings and determined to be CVS. Since the preoperative RPR and TPHA tests were positive, antibiotics were administered, but we did not recognize the CVS until the pathological results were reported, as has been previously reported [9, 10]. Cheng [10] has stated, “syphilitic aortitis is dying but not dead,” and Roberts et al [9] have stated, “cardiovascular syphilis has not disappeared” as well.…”

Section: Discussionmentioning

confidence: 98%

A case of acute myocardial infarction due to cardiovascular syphilis with aortic regurgitation and bilateral coronary ostial stenosis

2016

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We report an interesting case of a 66-year-old man with acute myocardial infarction (AMI) with bilateral coronary ostial stenosis cardiovascular syphilis complicated by aortic regurgitation (AR). A 12-lead electrocardiogram and blood tests on arrival suggested AMI, and echocardiography showed moderate AR. Emergency coronary angiography showed bilateral coronary ostial stenosis. The patient underwent emergency surgical treatment, coronary artery bypass grafting, and aortic valve replacement with a bioprosthetic valve. On arrival, rapid plasma reagin and Treponema pallidum hemagglutination tests were 172.2- and 1187.5-fold, respectively. These results suggested cardiovascular syphilis, which was confirmed by pathological findings. The postoperative course was uneventful and the patient was transferred to another hospital on postoperative day 25. This patient received intravenous penicillin for 2 weeks and subsequently oral amoxicillin. When both AR and coronary ostial stenosis are found, it is necessary to consider the presence of cardiovascular syphilis.

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Identifying Cardiovascular Syphilis at Operation

Cited by 24 publications

References 20 publications

Comparison of the Structure of the Aortic Valve and Ascending Aorta in Adults Having Aortic Valve Replacement for Aortic Stenosis Versus for Pure Aortic Regurgitation and Resection of the Ascending Aorta for Aneurysm

Comparison of the Structure of the Aortic Valve and Ascending Aorta in Adults Having Aortic Valve Replacement for Aortic Stenosis Versus for Pure Aortic Regurgitation and Resection of the Ascending Aorta for Aneurysm

Syphilis as a Cause of Thoracic Aortic Aneurysm

A case of acute myocardial infarction due to cardiovascular syphilis with aortic regurgitation and bilateral coronary ostial stenosis

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