Assuntos
Insuficiência da Valva Aórtica/história , Fitoterapia/história , Preparações de Plantas/história , Sífilis Cardiovascular/história , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/tratamento farmacológico , Insuficiência da Valva Aórtica/fisiopatologia , Digitalis/química , História do Século XVII , História do Século XVIII , Humanos , Literatura Moderna/história , Preparações de Plantas/uso terapêutico , Plantas Medicinais/química , Sífilis Cardiovascular/diagnóstico , Sífilis Cardiovascular/tratamento farmacológico , Sífilis Cardiovascular/fisiopatologiaAssuntos
Insuficiência da Valva Aórtica , Insuficiência Cardíaca , Penicilina G/administração & dosagem , Sífilis Cardiovascular , Treponema pallidum/isolamento & purificação , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Antibacterianos/administração & dosagem , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/cirurgia , Contagem de Linfócito CD4/métodos , Coinfecção , Ecocardiografia/métodos , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Minorias Sexuais e de Gênero , Sífilis Cardiovascular/complicações , Sífilis Cardiovascular/diagnóstico , Sífilis Cardiovascular/fisiopatologia , Sífilis Cardiovascular/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
INTRODUCTION: Aortitis is a well-recognized manifestation of the tertiary stage of syphilis. EVIDENCE ACQUISITION: Although often regarded as an unexpected diagnosis, actually new cases of cardiovascular syphilis continue to be reported. Presumably, Treponema pallidum invades the aortic wall and the inflammatory response progresses towards obliterative endarteritis and necrosis of the muscular and elastic fibers in the aortic media. The consequent weakening of the aortic wall can lead to severe complications, represented by aortic aneurysm, aortic valvular insufficiency, aortic root dilation and coronary ostial stenosis. We perused the literature of the last 6 years to assess the prevalence and possible changes over time of syphilis cardiovascular manifestations. EVIDENCE SYNTHESIS: Forty four articles were collected, reporting on 66 patients. Many patients presented more than one complication. Aortic aneurysm was the most frequent involvement, detected in 71% of patients. Fusiform or saccular aneurysms often interested the thoracic aorta, primarily located on the ascending segment. The second most common complication was the aortic valvular insufficiency, found in 47% of patients. Coronary ostial stenosis and dilation of the aortic root were less frequent. CONCLUSIONS: Comparing our study with the previous ones, the cardiovascular involvement appeared roughly constant over time. Although many articles fail to provide useful information, such as a detailed history and the presence of risk factors, we must note that most patients had no predisposing factors and denied a primary infection. Cardiovascular syphilis is still present nowadays and it is important not to forget the "great imitator" in the event of its characteristic symptoms.
Assuntos
Aorta/fisiopatologia , Sífilis Cardiovascular/fisiopatologia , Aneurisma Aórtico/etiologia , Insuficiência da Valva Aórtica/etiologia , Estenose Coronária/etiologia , Humanos , Sífilis Cardiovascular/complicações , Sífilis Cardiovascular/diagnósticoRESUMO
Electrocardiographic voltage has been used to determine the presence of left ventricular hypertrophy for about 70 years. Varying electrocardiographic criteria have been applied. We have found total 12-lead QRS voltage to be most useful in this regard. We measured total 12-lead QRS voltage in 24 patients in whom an ascending aortic aneurysm was resected and histologic study of its wall was classic of syphilitic aortitis. In these 24 patients total 12-lead QRS voltage ranged from 57 to 161 mm, averaging 120 ± 32 in the 11 men and 106 ± 24 mm in the 13 women. If normal 12-lead QRS voltage in adults is considered to be >175 mm not a single one of the 24 patients had normal voltage. Indeed, most were in the low normal area. Thus, this study provides some evidence via this indirect means that the heart itself is infrequently involved by syphilitic aortitis which produces an ascending aortic aneurysm of sufficient size to warrant resection.
Assuntos
Aneurisma Infectado/fisiopatologia , Aneurisma da Aorta Torácica/fisiopatologia , Aortite/fisiopatologia , Eletrocardiografia , Sífilis Cardiovascular/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Infectado/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Aortite/cirurgia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sífilis Cardiovascular/cirurgiaRESUMO
We present a 52-year-old male with a syphilitic aortic arch aneurysm accompanied by relevant extensive cerebral infarction. He was admitted to a local hospital for sudden loss of consciousness, where he was diagnosed with serious cerebral infarction. During his treatment, a multilocular aortic arch aneurysm involving the arch vessels was found incidentally. He was transferred to our hospital for surgical treatment. A preoperative routine laboratory test for syphilis was highly positive, which suggested that the aneurysm was likely caused by syphilis and the cerebral infarction was also induced by the involvement of syphilitic aortitis or arteritis. After 2 weeks of antibiotic therapy for syphilis, total arch replacement was performed successfully using meticulous brain protection with antegrade selective cerebral perfusion and deep hypothermia. He recovered without any further cerebral deficits. The pathological examination of the surgical specimen showed some characteristic changes of syphilitic aortitis.
Assuntos
Aneurisma Infectado/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Infarto Cerebral/terapia , Sífilis Cardiovascular/cirurgia , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiologia , Aneurisma Infectado/fisiopatologia , Antibacterianos/uso terapêutico , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/microbiologia , Aneurisma da Aorta Torácica/fisiopatologia , Aortografia/métodos , Biópsia , Infarto Cerebral/diagnóstico , Infarto Cerebral/microbiologia , Infarto Cerebral/fisiopatologia , Circulação Cerebrovascular , Parada Circulatória Induzida por Hipotermia Profunda , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Perfusão/métodos , Sífilis Cardiovascular/diagnóstico , Sífilis Cardiovascular/microbiologia , Sífilis Cardiovascular/fisiopatologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Insuficiência da Valva Aórtica/etiologia , Hipertrofia Ventricular Esquerda/etiologia , Sífilis Cardiovascular/fisiopatologia , Sífilis/fisiopatologia , Idoso , Insuficiência da Valva Aórtica/fisiopatologia , Cardiomegalia/etiologia , Cardiomegalia/patologia , Eletrocardiografia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertrofia Ventricular Esquerda/patologia , Masculino , Penicilinas/uso terapêutico , Sífilis/tratamento farmacológico , Sífilis Cardiovascular/tratamento farmacológicoRESUMO
The aneurismatic aortic disease is one of the most frequent conditions challenging the vascular surgeon. It can be caused by atherosclerosis, vasculitis, trauma, infection or others. The treatment, even when elective, can be associated to high rates of morbid-mortality, related to the etiology, anatomic location and type of treatment. The authors describe the case of a patient with concomitant syphilitic aneurysms of the descending thoracic aorta, pararenal and aortic bifurcation. The diagnostic presumption was supported by clinical and epidemiology data (the patient was treated for a syphilitic saccular infrarenal aortic aneurysm 5 years before). The etiology was confirmed by the pathological studies of the surgical specimen.
Assuntos
Aneurisma Infectado/microbiologia , Aneurisma da Aorta Abdominal/microbiologia , Aneurisma da Aorta Torácica/microbiologia , Sífilis Cardiovascular/fisiopatologia , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Sífilis Cardiovascular/diagnóstico , Sífilis Cardiovascular/cirurgiaRESUMO
Austin Flint murmur is a mid-diastolic rumbling audible in subjects with severe aortic regurgitation. Several theories have been raised to explain mechanistically the nature of this particular phenomenon. We briefly review severe aortic regurgitation under the light of contemporary echocardiography in an illustrative case.
Assuntos
Insuficiência da Valva Aórtica/fisiopatologia , Sopros Cardíacos/fisiopatologia , Adulto , Insuficiência da Valva Aórtica/diagnóstico por imagem , Ecocardiografia Doppler em Cores , Sopros Cardíacos/diagnóstico por imagem , Humanos , Masculino , Sífilis Cardiovascular/diagnóstico por imagem , Sífilis Cardiovascular/fisiopatologiaRESUMO
Os autores relatam um caso de aneurisma sifilítico da aorta (ASA) que, após o advento da antibioticoterapia quando ministrada nos estádios iniciais da doença, é de pouca incidência. A presunção diagnóstica foi corroborada por aspectos clínico-epidemiológicos sugestivos, radiografia e tomografia computadorizada do tórax, sendo confirmado pelo anatomopatológico da peça cirúrgica.
Assuntos
Humanos , Penicilina G Benzatina , Sífilis Cardiovascular/diagnóstico , Sífilis Cardiovascular/fisiopatologia , Sífilis Cardiovascular/terapia , Diagnóstico por Imagem , IncidênciaRESUMO
A 54-year-old man underwent aortic valve replacement for syphilitic aortic regurgitation. Eight years later, he was admitted with sudden precordial discomfort and symptoms of superior vena caval obstruction. Ascending aortic dissection was diagnosed by echocardiography and computed tomography of the thorax. The patient succumbed rapidly after admission. Postmortem findings and histological features were compatible with syphilitic aortitis, without significant atherosclerosis. This case report adds to the sparse literature on aortic dissection complicating syphilitic aortitis, and illustrates that, at certain stages of the disease process, syphilitic aortitis can lead to such a degree of mechanical instability of the aortic wall as to predispose to dissection.