Syphilis as a Cause of Thoracic Aortic Aneurysm




In 2009, we described morphologic findings in 22 patients having resection of an ascending aortic aneurysm in the previous 11 years at the Baylor University Medical Center, and histologic examination of the aneurysmal wall disclosed classic findings of syphilitic aortitis. The major purpose of that extensively illustrated report was to describe the characteristic gross features of the aneurysm such that syphilitic aortitis might be better recognized at operation and appropriate antibiotics administered postoperatively. The aim of the present study was to emphasize that syphilis remains a major cause of ascending aortic aneurysm. From January 1, 2009, to December 31, 2014, we studied additional 23 patients who had resection of an ascending aortic aneurysm that again histologically had classic features of syphilitic aortitis. All 23 patients were found to have syphilitic aortitis grossly and histologically. The aneurysm involved the ascending portion of aorta in all 23, the arch portion in 12, and the descending thoracic portion in 10. In conclusion, syphilis has far from disappeared. It remains a major cause of ascending aortic aneurysm.


In 2009, we described finding in 22 patients who underwent operative resection of an ascending aortic aneurysm at the Baylor University Medical Center (BUMC) from 1998 to 2008, and histologic examination of the aneurysmal wall was typical of syphilitic aortitis. The emphasis of that report was the describing of the morphologic features of syphilitic aortitis so that the condition could be more readily diagnosed at operation and also to emphasize that syphilis as a cause of thoracic aortic aneurysm had not disappeared. The present study was prompted by studying an additional 23 patients who underwent resection of an ascending aortic aneurysm caused by syphilitic aortitis at the same institution during the subsequent 6 years, again to emphasize that this condition has far from disappeared.


Methods


Since March 1993, all operatively excised specimens excised by cardiovascular surgeons at the BUMC have been described grossly and histologically by WCR and photographed mainly by JMK, and since 2003, the clinical records were available online. From January 1, 2009, to December 31, 2014, 23 patients were found to have diffuse panaortitis of the tubular portion of ascending aorta. The diffuseness of the involvement of the ascending aorta was determined by gross examination and the panaortitis by histologic examination. Takayasu’s arteritis was ruled out by the absence of giant cells in any layer of the aneurysmal wall. Ankylosing spondylitis was ruled out by the absence of arthritic disease, by the minimal involvement of the tubular portion of ascending aorta, by extension of the process into the walls of the sinus portion of aorta and onto the bases of the aortic valve cusps, and by the extension of the process onto the anterior mitral leaflet and into the membranous ventricular septum.


All 23 patients at operation were stated to have 3-cuspid aortic valves that were free of calcific deposits. The free margins, mainly their central portions, were described as being mildly thickened in some patients. The sinus portion of aorta was not dilated or described as being abnormal.


A positive or reactive serologic test for syphilis (STS) was not considered a criterion for inclusion in the present study because the test was never done in most patients, or, if performed, the results were unavailable.




Results


Pertinent findings in each of the 23 patients are listed in Table 1 . The 11 men ranged in age from 33 to 84 years (mean 61), and the 12 women from 58 to 83 years (mean 70). Eighteen were white; 4, black; and 1, Asian. The body mass index ranged from 16 to 47 kg/m 2 (mean 28); it was >25 in 15 (65%).



Table 1

Surgical cases of syphilitic aortitis at Baylor University Medical Center from January 1, 2009 to December 31, 2014










































































































































































































































































































































































































































































































Patient Age
(years) 		Race BMI
(Kg/m 2 ) 		Pressures (mmHg) (s/d) Aneurysm AVR Weight of AV (g) STS Result CABG
Location Type
LV SA Asc Arch DT Saccular Fusiform
MEN
1 33 W 24.7 118/27 132/72 + 0 0 0 + + 0.47 — — 0
2 45 B 23.0 — 180/100 + 0 0 + + 0 — + Ab, RPR 1:128 0
3 48 B 27.9 — 106/65 + + 0 + + 0 — — — 0
4 51 W 28.1 148/20 131/60 + 0 0 0 + 0 — 0 — 0
5 59 A 28.4 — 170/80 + + + + + 0 — 0 — 0
6 59 B 34.4 — 120/70 + + 0 0 + + 0.83 0 — 0
7 60 W 28.9 120/7 140/90 + + 0 0 + 0 — 0 — 0
8 70 W 37.7 190/40 190/90 + + + 0 + 0 — 0 — +
9 80 W 28.0 123/5 145/85 + + + 0 + 0 — 0 — +
10 83 W 24.4 130/10 150/80 + 0 0 0 + + 0.91 0 — +
11 84 W 26.5 120/20 120/70 + + + 0 + + 0.86 0 — +
33-84 23.0-37.7
(61±17) (28.4±4.3)
WOMEN
1 58 B 31.7 126/30 140/90 + 0 0 0 + 0 — 0 — 0
2 59 W 28.9 0 160/90 + + + 0 + 0 — 0 — 0
3 62 W 45.6 155/25 170/65 + 0 + + + + 0.78 + NR (Ab) 0
4 65 W 46.5 114/16 120/65 + 0 + 0 + 0 — 0 — 0
5 65 W 28.9 142/10 130/75 + + + 0 + 0 — 0 — 0
6 67 W 26.2 124/4 135/60 + 0 0 0 + 0 — + NR (Ab) 0
7 69 W 15.8 101/3 100/60 + 0 + 0 + 0 — 0 — +
8 70 W 21.6 — 170/80 + 0 0 0 + 0 — + NR (RPR) 0
9 79 W 24.8 — 140/55 + + + + + 0 — 0 — +
10 80 W 28.6 145/30 145/60 + 0 0 0 + 0 — + NR (RPR) 0
11 83 W 18.6 175/20 175/70 + 0 0 0 + + 0.55 0 — 0
12 83 W 22.3 120/10 120/40 + 0 0 0 + 0 — 0 — 0
58-83 15.8-46.5
(70±9) (28.3±9.5)

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Nov 28, 2016 | Posted by in CARDIOLOGY | Comments Off on Syphilis as a Cause of Thoracic Aortic Aneurysm

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