Late aneurysm formation of Valsalva sinus after aortic valve replacement due to Takayasu’s arteritis

Abstract

Takayasu's arteritis (TA) is an inflammatory disease of unknown etiology involving the aorta and its branches, and also causes aortic regurgitation (AR). One of the most serious but rare complications after aortic valve replacement (AVR) in TA is aneurysm formation of the sinus of Valsalva. A 64-year-old woman had undergone AVR with a prosthetic valve for AR due to TA 4 years earlier and had received an implanted permanent pacemaker for complete atrioventricular block (AVB) 2 years later. Aortography 4 years postoperatively demonstrated aneurysm formation (47 mm in diameter) at the sinus of Valsalva although preoperative aortography showed severe AR without dilatation of the sinus of Valsalva. We recommended reoperation for the aneurysm but the patient refused. The perioperative histopathological examination revealed extensive destruction of the medial elastic fibers. Both the fragility of the sinus of Valsalva and the residual inflammation could have caused the patient's aneurysm formation. Moreover, extension of TA into the ventricular septum or mechanical compression of the aneurysm against the conduction system might have caused her progressive AVB. Close and lifelong follow-up for patients with TA regarding development of aneurysm after surgical treatment is indispensable when fragility of the aortic root had been confirmed.

Aortic regurgitation and aortic valve operation in Takayasu arteritis: A meta-analysis

“…[12,14,15,20,23,24,28,[30][31][32]47] The degree of AR was not reported in 118 patients (74.2%). [10,16,18,22,26,35,38,45,50] In the remaining 41 patients (25.8%), one (2.4%) was mild, [29] nine (22.0%) were moderate, [11,12,23,34,37,41,42,49] one (2.4%) was moderate-to-severe [37] and 30 (73.2%) were severe [13][14][15]17,[19][20][21]24,25,27,28,[30][31][32][33]36,39,40,[42][43][44]…”

“…[48] In 33 patients (20.8%), the type of TA could be tracked: five (15.2%) were type 1, [28,33,34,37,47] 21 (63.6%) were type 2a, [11][12][13][14][17][18][19][20][21][22][23][24]27,29,30,36,38,39,46,48,49] one (3.0%) was type 2b, [31] three (9.1%) were type 3, [32,40,41] two (6.1%) were type 4, and one (3.0%) was type 5. [16] The activity of TA could be traced in 42 patients (26.4%): 37 (88.1%) were active [12,[14][15][16][18][19][20][21][22][23][24]26,28,[30][31][32]36,37,…”

“…[10][11][12]14,15,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][38][39][40]42,[44][45][46][47][48][49][50] The aortic valve operations that were performed in these patients were: aortic valve repair in three (2%) [12,30,32] (in one of them, aortic valve repair was performed after a three-week steroid treatment), [32] aortic valve replacement in 98 (65.3%), [10,11,14,17,18,20,[22][23][24][25]...…”

“…In the surgical group, postoperative cardiac complications occurred in 31 patients (20.7%), [20][21][22][23]32,35,36,38,42,44,47,49,50] and complications occurred twice in one patient at postoperative 18 months and 14 years, respectively. [50] The timing of complication development was at 66.0±70.1 months (range 0.5-204 months; median 36 months) (n=16) postoperatively.…”

“…[50] The timing of complication development was at 66.0±70.1 months (range 0.5-204 months; median 36 months) (n=16) postoperatively. Reintervention for complications was warranted in 13 patients (41.9%), [10,[21][22][23]35,36,38,42,44,47] but Yuan. Aortic regurgitation in Takayasu arteritis one patient refused.…”