Related Experiment Videos
[A case of left coronary ostial obstruction due to syphilitic aortitis]
H Nakashima1, A Takahara, M Yoshioka
1Department of Internal Medicine, Kohseikai Hospital.
Insights
Syphilitic aortitis can cause rare coronary ostial stenosis, leading to significant left coronary ostium obstruction. This case highlights the importance of considering syphilitic infection in patients with angina and specific cardiac findings.
Area of Science:
- Cardiology
- Infectious Diseases
- Vascular Medicine
Background:
- Coronary ostial stenosis is a rare condition.
- It can be a complication of various diseases including syphilitic aortitis, Takayasu's aortitis, aortic valve disease, and familial hypercholesterolemia.
Observation:
- A 67-year-old man presented with a decade of exertional angina.
- Physical examination revealed a diastolic murmur; serological tests (TPHA, FTA-ABS) were positive for syphilis.
- Coronary angiography showed complete obstruction of the left coronary ostium with collateral supply from the right coronary artery.
Findings:
- Syphilitic aortitis was identified as the cause of left coronary ostial obstruction.
- Angiographic features of syphilitic coronary ostial stenosis include ostial limitation, severe stenosis (>90%), potential bilateral involvement, and frequent association with aortic regurgitation.
Implications:
- This case underscores the need to include syphilitic aortitis in the differential diagnosis of coronary ostial stenosis.
- Understanding the characteristic angiographic findings aids in accurate diagnosis and management of this rare complication.
- Early diagnosis and treatment of syphilitic aortitis can prevent severe cardiac complications like coronary ostial stenosis.
Abstract:
Coronary ostial stenosis is a rare lesion, which is a complication of syphilitic aortitis, Takayasu's aortitis, aortic valve disease, and familial hypercholesterolemia. We present a case of left coronary ostial obstruction due to syphilitic aortitis. A 67 years old man was admitted to our hospital for evaluation of a ten year history of angina on exertion. On physical examination, the only abnormal finding was a grade 2/6 high-pitched diastolic murmur. Coronary risk factor was not detected from biochemical results, but both the TPHA and FTA-ABS test were positive. Treadmill stress test showed more than 2 mm ST segment depression associated with chest pain. Coronary angiography revealed complete obstruction of left coronary ostium with good collaterals from the right coronary artery. The coronary arterial tree was otherwise normal. Furthermore, aortagraphy showed a moderate degree of aortic regurgitation. From the examination of previous reports including our own case, we think that the angiographic features of syphilitic coronary ostial stenosis can be summarized as below. 1. Coronary artery stenosis is generally limited to the ostium. 2. The grade of stenosis almost always shows more than 90% stenosis, and sometimes bilateral coronary ostium can be affected. 3. Aortic regurgitation is frequently noted, associated with coronary ostial stenosis.