THE 'TAK'ING TIME BOMB: TAKAYASU ARTERITIS IN A YOUNG FEMALE

Abstract

Takayasu Arteritis is a rare, inflammatory vasculitis that affects the large vessels and can manifest systemically. It most commonly presents in women of childbearing age. This young lady presented with an eighteen month history of low energy, fatigue, nausea, vomiting, and weight loss of 20 kgs over an 18 month period. During a routine exam, her GP noted a new murmur and an echocardiogram revealed a massively dilated ascending aorta with severe aortic regurgitation. Cardiovascular magnetic resonance imaging revealed involvement of the carotid arteries and intracerebral vessels. She was admitted to hospital in an acute inflammatory state with cardiology, rheumatology, and cardiovascular surgery involvement. Treatment was initiated with IV steroids and immunosuppressive therapy prior to surgery. After 6 weeks of treatment a positron emission tomography (PET) scan re-evaluated the degree of inflammation and she was deemed ready for aortic surgery. She underwent a successful mechanical aortic valve, root reconstruction, coronary re-implantation, ascending and hemi-arch replacement. Her post-operative course was complicated by third degree heart block, pericarditis, and infection, presumably related to immunosuppression. This presentation will discuss her initial presentation, diagnosing characteristics, medical and surgical implications, post-operative challenges, and long-term management. It will highlight takayasu arteritis including the six different types, with a focus on type 2A as diagnosed in this young female.