Major Aortic Reconstruction with the Replacement of Supra-Aortic Branches: Successful Surgical Treatment of Takayasu Arteritis Initially Presented as Congestive Heart Failure.

Maja Stojanovic,Aleksandra Peric-Popadic,Ilija Bilbija,Vesna Bozic,Maja Vuckovic,Sanvila Raskovic,Marija Boricic-Kostic

doi:10.3390/diagnostics11020216

Abstract

Takayasu arteritis (TA) is a rare, large vessel vasculitis that affects aorta, its major branches, and occasionally pulmonary arteries. Patients with TA can present with constitutional features and/or various symptoms and signs caused by morphological changes in the blood vessels affected by the inflammatory process. Corticosteroids (CS) and immunosuppressives (IS) are the first line treatment for active TA. Open surgery remains a treatment of choice for TA patients with moderate-to-severe aortic regurgitation (AR) and ascending aortic aneurysm (AAA). We present a 26-year-old female diagnosed with an advanced stage of TA, initially presented as congestive heart failure. Due to a progressive course of the disease (AR 3+, AAA 5.5 cm), surgery of the Aortic valve and root (Bentall procedure), with total arch reconstruction and replacement of supra-aortic branches was performed. The patient has had an uneventful recovery during the postoperative course with no complications at one year follow-up. Normal left ventricle (LV) diameter, LV ejection fraction 67%, and a trace of AR were seen on the last echocardiography.

Highlights

Aortic Reconstruction with the Replacement of Supra-Aortic Branches: Successful Surgical Treatment of Takayasu Arteritis Initially Presented as Congestive Heart Failure
Patients with Takayasu arteritis (TA) can present with constitutional features, or various symptoms and signs caused by morphological changes in the vessels affected by the inflammatory process: bruits, absent or diminished pulses, reduced or asymmetric blood pressure, claudication, ishaemic/congestive heart disease or neurological symptoms [2]
Corticosteroids and immunosuppressives are considered the first line treatment in all patients with active TA, while biologics should be considered in case of relapsing or refractory disease [4]

Summary

Introduction

Aortic Reconstruction with the Replacement of Supra-Aortic Branches: Successful Surgical Treatment of Takayasu Arteritis Initially Presented as Congestive Heart Failure. Patients with TA can present with constitutional features (fever, malaise, anorexia, and weight loss), or various symptoms and signs caused by morphological changes in the vessels affected by the inflammatory process: bruits, absent or diminished pulses, reduced or asymmetric blood pressure, claudication, ishaemic/congestive heart disease or neurological symptoms [2]. Based on clinical features and typical angiographic findings, the patient fulfilled the 1990 American College of Rheumatology (ACR) classification criteria for TA [3].

Results

Conclusion