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Annuloaortic ectasia and giant cell arteritis.
Sandro Gelsomino1, Stefano Romagnoli, Franca Gori
1Department of Cardiac Surgery, Careggi Hospital, Florence, Italy. sandrogelsomino@virgilio.it
The Annals of Thoracic Surgery
|June 25, 2005
Summary
Giant cell arteritis (GCA), also known as Horton disease, frequently causes annuloaortic ectasia, leading to aortic regurgitation. Surgical replacement of the aortic root is recommended for all GCA patients, irrespective of initial appearance.
Area of Science:
- Cardiovascular Surgery
- Rheumatology
- Vascular Medicine
Background:
- Giant cell arteritis (GCA), or Horton disease, is associated with thoracic aortic aneurysms, dissection, and aortic valve regurgitation.
- This study reviews midterm outcomes in patients with these concurrent conditions.
Purpose of the Study:
- To evaluate the midterm experience and outcomes of surgical interventions for thoracic aortic pathology in patients with giant cell arteritis.
- To determine the optimal surgical approach for aortic root involvement in GCA.
Main Methods:
- Retrospective review of 386 ascending aorta and aortic valve replacement cases (1998-2004).
- Identification of 10 patients with histopathologically confirmed GCA.
- Analysis of surgical procedures, including Bentall operation, hemiarch, and total arch replacement.
Main Results:
- Annuloaortic ectasia was present in 80% of GCA patients, necessitating Bentall procedures.
- Two patients without apparent sinus dilation required reoperation due to subsequent native sinus dilation.
- Midterm survival was high (90%), with 6-year freedom from reoperation at 77%.
Conclusions:
- Annuloaortic ectasia is a frequent manifestation of GCA.
- Prophylactic replacement of the aortic root is advised in all patients with Horton disease, regardless of initial macroscopic assessment of the aortic sinuses.