Ascending Aortic Aneurysm In Giant Cell Arteritis

Abstract

Giant cell arteritis(GCA) is a relatively common form of systemic vasculitis. GCA is a systemic vasculitis which involves large and medium sized vessels,and it increases the risk of developing a thoracic aortic aneurysm and it is a rare cause.We describe a case of ascending aortic aneurysm in giant cell arteritis. The treating physician should be vigilant in assessing the patient with GCA for thoracic and abdominal aortic aneurysms that are feared complications of GCA. INTRODUCTION Giant cell arteritis(GCA) is a mediumand large-vessel vasculitis, the most prevalent systemic vasculitis in subjects over age 60. Clinical features are miscellaneous and sometimes misleading. Elevated acute-phase responses, such as a high erythrocyte sedimentation rate and increased levels of C-reactive protein, are important clues to the diagnosis, which is ensured by a positive temporal artery biopsy[1]. Additional vascular manifestations include stroke, aortic aneurysm or dissection, and even aortic rupture[2]. CASE PRESENTATION Our case was a 59-year-old female. Her past medical history was significant for hypertension for 10 years. Moreover, she had been diagnosed as having GCA confirmed with biopsy of superficial temporal artery a year ago. Therefore she had been under steroid therapy since then. She also had an aneurysmal dilation of the ascending aorta (54 mm) which was revealed 3 years ago during investigations for palpitation.In transthoracic echocardiogram ascending aortic aneurysm size was 55mm and she had moderate aortic regurgitation. Cardiac catheterization was performed. Ascending aortic dilation was investigated(Figure 1). Coronary arteries were normal. Department of Rheumatology was consulted for preand postoperative recommendations. Figure 1 Figure 1 She was operated under endotracheal general anesthesia and in supine position.Following a median sternotomy,pericardium was opened longitudinally. Ascending aorta was dilated. Since there was a suitable neck just proximal to brachiocephalic trunk, neither axillary nor femoral cannulation was needed. After heparinization, extracorporeal circulation was established between the venae cavae and the ascending aorta. A cross clamp was placed on aorta and by retrograde continuous isothermic blood Ascending Aortic Aneurysm In Giant Cell Arteritis 2 of 5 cardioplegia from coronary sinus,cardiac arrest was established.Hypothermia was moderate (28oc).A vent was placed via the right superior pulmonary vein.Standard aortotomy was made. There was an aortic segment right proximal to the crossclamp, suitable for distal anastomosis. Aortic valve was explored. There was a calcified verrucous structure of 0.5x0.5 cm on the ventricular aspect of the free edge of the right coronary cusp (Figure 2).