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Surgical repair for giant ascending aortic aneurysm to superior vena cava fistula with positive syphilitic test.

Sekine Y, Yamamoto S, Fujikawa T, Oshima S, Ono M, Sasaguri S - Gen Thorac Cardiovasc Surg (2013)

Bottom Line: The result of serodiagnostic tests for syphilis had not been judged yet preoperatively.Postoperatively, we suspected the syphilitic aneurysm strongly, because preoperative serodiagnostic test was concluded to be positive.However, histological examination did not show typical syphilitic features.

View Article: PubMed Central - PubMed

Affiliation: Department of Aortic Surgery, Kawasaki Saiwai Hospital, 31-27 Omiyacho, Saiwai ward, Kawasaki, 212-0014, Japan. yuji-sekine@kif.biglobe.ne.jp.

ABSTRACT
Syphilitic aortitis is usually associated with thoracic aortic saccular aneurysm, aortic regurgitation and coronary ostial stenosis. However, syphilitic aneurysms have rarely been reported today. Here, we report a patient with ascending aortic aneurysm with aorta-superior vena cava (SVC) fistula with positive syphilitic test. A 52-year-old man was admitted to our institution with a giant ascending aortic aneurysm complicated with SVC syndrome. Computed tomography revealed a giant ascending aneurysm 79 mm in diameter. The result of serodiagnostic tests for syphilis had not been judged yet preoperatively. Total arch replacement concomitant with elephant trunk was performed. Intraoperatively, we detected the ascending aorta to SVC fistula. Postoperatively, we suspected the syphilitic aneurysm strongly, because preoperative serodiagnostic test was concluded to be positive. However, histological examination did not show typical syphilitic features. The patient remains asymptomatic 1 year later. Although extremely rarely today, syphilitic aneurysm should be still considered in the differential diagnosis of ascending aortic aneurysm.

No MeSH data available.


Related in: MedlinePlus

Preoperative computed tomography showing giant ascending aortic aneurysm with the dimension of 79 mm in size and severely compressed SVC
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Fig1: Preoperative computed tomography showing giant ascending aortic aneurysm with the dimension of 79 mm in size and severely compressed SVC

Mentions: A 52-year-old man had suffered from severe edema of his face and upper extremity. He was diagnosed with SVC syndrome and referred to our institution for the treatment of SVC syndrome. Computed tomography scan revealed giant ascending aortic aneurysm with the dimension of 79 mm in size and SVC was compressed severely by ascending aorta (Fig. 1). Echocardiography showed moderate aortic regurgitation and no dilatation of left ventricle. Coronary angiography showed normal coronary arteries including normal coronary ostia. Although we had checked serodiagnostic tests for syphilis, Treponema pallidum hemagglutination reaction (TPHA) and fluorescence test assay absorption (FTA-ABS), the results of their examination were not revealed preoperatively. We performed surgical repair of the aortic aneurysm via median sternotomy in a usual manner. However, we detected moderate serous pericardial effusion and severe adhesion around ascending aorta. We could not dissect between ascending aorta and SVC because of severe adhesion. Cardiopulmonary bypass (CPB) was established between bilateral vena cava drainage and right femoral artery perfusion. The patient was cooled to the core temperature of 25 °C, the aneurysm was opened under deep hypothermic circulatory arrest and selective cerebral perfusion was established. Cardiac standstill was established by retrograde and selective cardioplegic infusion. The marked adhesion was detected around distal aortic arch suggesting the inflammatory process around the aorta. The distal anastomosis was performed at 6 cm distal site from left subclavian artery. Since the anastomotic site was slightly dilated, elephant trunk technique was performed simultaneously. After the distal anastomosis under open distal technique, three neck vessels were reconstructed individually. When we started systemic rewarming, we detected the bleeding from the hole of the opened aortic wall. The hole was slit shape and 8 × 1 mm in size. We diagnosed the fistula between ascending aorta and SVC, and closed the fistula with 4-0 polypropylene in a running fashion. The weaning from CPB was uneventful. Postoperatively, we suspected syphilitic aneurysm because we could find that the preoperative serodiagnostic tests were all positive. Although postoperative histological examination of the aneurysmal wall did not show typical syphilitic features, obliterative endarteritis and fibrosis at vasa vasorum, the severely changed tunica media could be detected (Fig. 2a, b). Therefore, we diagnosed syphilitic aneurysm clinically. Penicillin G was administered intravenously for 4 weeks. The patient was discharged from our hospital on postoperative day 45. The patient remains asymptomatic 1 year later.Fig. 1


Surgical repair for giant ascending aortic aneurysm to superior vena cava fistula with positive syphilitic test.

Sekine Y, Yamamoto S, Fujikawa T, Oshima S, Ono M, Sasaguri S - Gen Thorac Cardiovasc Surg (2013)

Preoperative computed tomography showing giant ascending aortic aneurysm with the dimension of 79 mm in size and severely compressed SVC
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4594086&req=5

Fig1: Preoperative computed tomography showing giant ascending aortic aneurysm with the dimension of 79 mm in size and severely compressed SVC
Mentions: A 52-year-old man had suffered from severe edema of his face and upper extremity. He was diagnosed with SVC syndrome and referred to our institution for the treatment of SVC syndrome. Computed tomography scan revealed giant ascending aortic aneurysm with the dimension of 79 mm in size and SVC was compressed severely by ascending aorta (Fig. 1). Echocardiography showed moderate aortic regurgitation and no dilatation of left ventricle. Coronary angiography showed normal coronary arteries including normal coronary ostia. Although we had checked serodiagnostic tests for syphilis, Treponema pallidum hemagglutination reaction (TPHA) and fluorescence test assay absorption (FTA-ABS), the results of their examination were not revealed preoperatively. We performed surgical repair of the aortic aneurysm via median sternotomy in a usual manner. However, we detected moderate serous pericardial effusion and severe adhesion around ascending aorta. We could not dissect between ascending aorta and SVC because of severe adhesion. Cardiopulmonary bypass (CPB) was established between bilateral vena cava drainage and right femoral artery perfusion. The patient was cooled to the core temperature of 25 °C, the aneurysm was opened under deep hypothermic circulatory arrest and selective cerebral perfusion was established. Cardiac standstill was established by retrograde and selective cardioplegic infusion. The marked adhesion was detected around distal aortic arch suggesting the inflammatory process around the aorta. The distal anastomosis was performed at 6 cm distal site from left subclavian artery. Since the anastomotic site was slightly dilated, elephant trunk technique was performed simultaneously. After the distal anastomosis under open distal technique, three neck vessels were reconstructed individually. When we started systemic rewarming, we detected the bleeding from the hole of the opened aortic wall. The hole was slit shape and 8 × 1 mm in size. We diagnosed the fistula between ascending aorta and SVC, and closed the fistula with 4-0 polypropylene in a running fashion. The weaning from CPB was uneventful. Postoperatively, we suspected syphilitic aneurysm because we could find that the preoperative serodiagnostic tests were all positive. Although postoperative histological examination of the aneurysmal wall did not show typical syphilitic features, obliterative endarteritis and fibrosis at vasa vasorum, the severely changed tunica media could be detected (Fig. 2a, b). Therefore, we diagnosed syphilitic aneurysm clinically. Penicillin G was administered intravenously for 4 weeks. The patient was discharged from our hospital on postoperative day 45. The patient remains asymptomatic 1 year later.Fig. 1

Bottom Line: The result of serodiagnostic tests for syphilis had not been judged yet preoperatively.Postoperatively, we suspected the syphilitic aneurysm strongly, because preoperative serodiagnostic test was concluded to be positive.However, histological examination did not show typical syphilitic features.

View Article: PubMed Central - PubMed

Affiliation: Department of Aortic Surgery, Kawasaki Saiwai Hospital, 31-27 Omiyacho, Saiwai ward, Kawasaki, 212-0014, Japan. yuji-sekine@kif.biglobe.ne.jp.

ABSTRACT
Syphilitic aortitis is usually associated with thoracic aortic saccular aneurysm, aortic regurgitation and coronary ostial stenosis. However, syphilitic aneurysms have rarely been reported today. Here, we report a patient with ascending aortic aneurysm with aorta-superior vena cava (SVC) fistula with positive syphilitic test. A 52-year-old man was admitted to our institution with a giant ascending aortic aneurysm complicated with SVC syndrome. Computed tomography revealed a giant ascending aneurysm 79 mm in diameter. The result of serodiagnostic tests for syphilis had not been judged yet preoperatively. Total arch replacement concomitant with elephant trunk was performed. Intraoperatively, we detected the ascending aorta to SVC fistula. Postoperatively, we suspected the syphilitic aneurysm strongly, because preoperative serodiagnostic test was concluded to be positive. However, histological examination did not show typical syphilitic features. The patient remains asymptomatic 1 year later. Although extremely rarely today, syphilitic aneurysm should be still considered in the differential diagnosis of ascending aortic aneurysm.

No MeSH data available.


Related in: MedlinePlus