A Case of Ostial Stenosis of the Left Main Coronary Artery and Aortic Valve Insufficiency due to Syphilitic Aortitis―Surgical Ostial Angioplasty with Fresh Autologous Pericardium―

(Department of Cardiovascular Surgery, Oji General Hospital, Tomakomai, Japan)

Tomonori Ooka IYutaka Makino Tatsuya Murakami
We report a case of surgical ostial angioplasty with fresh autologous pericardium concomitant with aortic valve replacement for ostial stenosis of the left main coronary artery (LMT) with aortic valve insufficiency due to syphilitic aortitis (SA). A 50-year-old man with chronic atrial fibrillation and a history of multiple cerebral infarctions was found to have a 90% ostial stenosis of the LMT with an intact distal coronary artery tree. On preoperative echocardiography, severe aortic valve insufficiency and left atrial thrombus were noted. A chest CT showed no thickening or dilatation of the ascending aorta and no calcification of the aortic root and LMT. As a serological syphilitic test, the treponema pallidum hemagglutination test was positive in 1: 10,387 dilution with a positive rapid plasma reagin method. He had no chest pain or fever. At surgery, gross thickening and fibrosis of the ascending aortic wall extending from the aortic root was noted, suggesting aortitis such as Takayasu aortitis and SA. The aortic valve was replaced with a mechanical valve and the LMT was successfully enlarged with a fresh autologous pericardial patch, confirmed by postoperative coronary angiography. Pathological findings of the aortic wall and the valve were consistent with SA, where treponema pallidum was found immunohistologically. He had an uneventful postoperative course and was treated with a 3.5-month course of amoxicillin (750mg/day) for cardiovascular syphilis. Although SA is rarely seen nowadays, we should consider the possibility of this disease if there is a combination of coronary ostial stenosis and aortic valve insufficiency. Since surgical coronary ostial angioplasty has never been applied for SA, a careful observation is required.
 Jpn. J. Cardiovasc. Surg. 35: 155-159 (2006)