Coronary artery aneurysms: A transesophageal echocardiographic study

Abstract

symptoms are usually valvular dysfunction2 or atrioven- tricular conduction abnormalities.'-3 The most common valvular dysfunction is aortic insufficiency, which has been reported to be present in approximately 15% of cases of ankylosing spondylitis4 and characteristically occurs with peripheral joint involvement. Less frequently, mitral in- sufficiency may be the valvular dysfunction and, rarely, combined aortic and mitral insufficiency occurs.4 Usually cardiovascular symptoms are preceded by many years of clinical ankylosing spondylitis, although in some instances the valvular function has antedated the clinical evidence of spondylitis. Ankylosing spondylitis has been reported to be present in 2 '( to 16 '% patients with Crohn's disease.5 In a few pa- tients with ankylosing spondylitis and Crohn's disease, aortic valvular insufficiency has been noted.2 However, the association of valvular heart disease and Crohn's disease in the absence of ankylosing spondylitis has not been previ- ously reported. In our two patients the morphologic and histologic valvular findings (Table I); Figs. 1 and 2) are similar to those reported in previous studies of valvular abnormalities associated with ankylosing spondylitis.3-4 In the first instance the echocardiographic findings are also similar to the valvular abnormalities reported in associa- tion with ankylosing spondylitis.6 In both patients the di- agnosis of Crohn's disease was diagnosed by radiographic and histologic findings. Clinical and radiologic findings of ankylosing spondylitis were absent in both instances, as was tissue typing for HLA B27. We assume that the valvular dysfunction in these two patients does represent an inflammatory process and most likely is the same process that has been reported in valvu- iar cases associated with enteropathic spondylitis. We are unsure about the absence in our patients of clinical or ra- diographic evidence of ankylosing spondylitis. As previ- ously reported it is possible that with longer follow-up ankylosing spondylitis will become evident; however, in both patients the follow-up periods have been lengthy. We propose that in certain individuals with Crohn's disease, associated cardiovascular lesions may occur independent of ankylosing spondylitis.