Abstract
We report an interesting case of a 66-year-old man with acute myocardial infarction (AMI) with bilateral coronary ostial stenosis cardiovascular syphilis complicated by aortic regurgitation (AR). A 12-lead electrocardiogram and blood tests on arrival suggested AMI, and echocardiography showed moderate AR. Emergency coronary angiography showed bilateral coronary ostial stenosis. The patient underwent emergency surgical treatment, coronary artery bypass grafting, and aortic valve replacement with a bioprosthetic valve. On arrival, rapid plasma reagin and Treponema pallidum hemagglutination tests were 172.2- and 1187.5-fold, respectively. These results suggested cardiovascular syphilis, which was confirmed by pathological findings. The postoperative course was uneventful and the patient was transferred to another hospital on postoperative day 25. This patient received intravenous penicillin for 2 weeks and subsequently oral amoxicillin. When both AR and coronary ostial stenosis are found, it is necessary to consider the presence of cardiovascular syphilis.
Highlights
Syphilis is an ancient disease and an important issue internationally among sexually transmitted diseases [1]
We report a patient with acute myocardial infarction (AMI) and Cardiovascular syphilis (CVS), which were associated with both aortic regurgitation (AR) and bilateral coronary ostial stenosis
Considering the histological characteristics of the aortic wall, there are concerns about proximal anastomotic stenosis of the Saphenous vein graft (SVG) [5]. This risk may decrease by using the internal thoracic artery in situ, but stenosis of the aortic branch is not completely resolved because the syphilitic process has been reported to extend to the aortic arch at a rate of 91% [13] and sometimes to the arch vessels [14]
Summary
Syphilis is an ancient disease and an important issue internationally among sexually transmitted diseases [1]. Many reports have shown an association with aortic aneurysm [3] and coronary ostial stenosis [4]. We report a patient with acute myocardial infarction (AMI) and CVS, which were associated with both aortic regurgitation (AR) and bilateral coronary ostial stenosis.
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