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[Surgical treatment of syphilitic ascending aortic aneurysm: a case report]
Insights
Syphilis can cause aortic aneurysms and dissections, leading to serious complications like stroke. Surgical graft replacement requires careful consideration of internal aortic wall changes, not just external size.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Neurology
Background:
- Syphilis infection can lead to cardiovascular complications, including aortic aneurysms.
- A 67-year-old male patient with known ascending and abdominal aortic aneurysms presented with transient ischemic attack.
Observation:
- The patient underwent surgical resection of a saccular ascending aortic aneurysm with patch plasty.
- Intraoperative findings included a mildly dilated aorta and arch with intimal ulcerations.
- Postoperatively, the patient experienced multiple cerebral infarctions attributed to embolic events.
Findings:
- Microscopic examination of the resected aneurysm wall confirmed syphilitic changes.
- Despite prompt neurological improvement, residual mild hemiparesis was noted.
Implications:
- This case highlights the importance of considering syphilitic aortitis in aneurysm etiology.
- Surgical planning for aortic replacement must account for internal aortic wall integrity, not solely external dimensions.
- Internal aortic pathology, such as syphilitic changes, can increase embolic risk even after successful surgical repair.
Abstract:
A 67-year-old man with positive serum reaction for syphilis had been followed by cardiologist for his moderate-sized saccular ascending aortic aneurysm and small-sized abdominal aortic aneurysm. Because of his transient ischemic attack probably secondary to the thrombo-embolism of the aneurysm and rapid growing of its size, surgical treatment was recommended. Resection of the saccular aneurysm with patch plasty of the ascending aorta was performed under the cardiopulmonary bypass associated with right side cerebral perfusion. At the time of operation, the mildly dilated ascending aorta and arch with multiple intimal ulceration were noted. Although his postoperative hemodynamic condition was stable, he suffered from multiple cerebral infarction, probably due to embolism migrated from the fragile aortic intima. His neurological condition was improved promptly, trivial hemi-paralysis was remained. The specimen of resected aneurysmal wall revealed syphilitic changes microscopically. We concluded that the extent of the aortic replacement with prosthetic graft should be deceived not only with its external appearance, but also with the changes of its inside.