Syphilitic aortitis, passing out of our mind, is the most common systemic manifestation of late syphilis and is more typically manifestated 10 to 30 years afterward. This diagnosis has been made less frequently in recent decades than in the past, because of public awareness of syphilis and screening program. Treponema pallidum lodge within vasa vasorum, especially ascending aorta cause the histologic changes, which are responsible for the three major forms of symptomatic cardiovascular syphilis, including aortic insufficiency, coronary ostial stenosis, and aortic aneurysm. We experienced a case of syphilitic aortitis with aortic insufficiency and aortic aneurysm in a 48-year-old man presented with progressive dyspnea. Echocardiography, chest CT, and later surgical correction were performed and surgical specimen revealed the histologic finding consistent with syphilitic aortitis. We report this case with a review of the literature.
Aorta ; Aortic Aneurysm* ; Aortitis ; Constriction, Pathologic ; Diagnosis ; Dyspnea ; Echocardiography ; Humans ; Mass Screening ; Middle Aged ; Syphilis ; Syphilis, Cardiovascular* ; Tomography, X-Ray Computed ; Treponema pallidum ; Vasa Vasorum

BACKGROUND: Coronary artery bypass grafting(CABG) has been established as an effective treatment modality in improving the symptoms of ischemic heart disease as well as in preventing sudden death. Since the relatively wide use of arterial grafting in the 80's, an improvement in long term patency rates compared with saphenous vein grafting has been suggested. We have been using multiple arterial grafts since 1998, and we attempted to compare our early results with those of saphenous vein grafting. MATERIAL AND METHOD: Out of the 355 patients that received CABG at our center between June,1998 and May,1999, 153 patients that used cardioplegia were reviewed. 76 had received single arterial graft(Group I) and 77 had received more than 2 arterial grafts(Group II). Preoperative clinical data, ecohocardiography, and angiographic studies were analyzed retrospectively. RESULT: Preoperatively, there were statistically significant differences between Group I and Group II with respect to age and smoking history. There was one early postoperative mortality in each group. The number of anastomoses constructed per patient showed a statistical difference. There were no other differences in operative and postoperative results. CONCLUSION: Even in our learning period, there was no difference in our early results between arterial grafting and saphenous vein grafting. These early results suggest that arterial grafting may afford patients as improving in late survival. Futhermore, these results suggest that complete arterial revasularization may serve to prolong life expectancy.
Coronary Artery Bypass* ; Coronary Vessels* ; Death, Sudden ; Heart Arrest, Induced ; Humans ; Learning ; Life Expectancy ; Mortality ; Myocardial Ischemia ; Retrospective Studies ; Saphenous Vein ; Smoke ; Smoking ; Transplants*

BACKGROUND: The intracoronary stent implantation is accepted as the treatment modality to reduce restenosis in comparison with balloon angioplasty in patients with coronary artery disease. In recent studies, the technique of high pressure balloon dilation for stent optimization has been shown to improve procedural success and to reduce the subacute closure after stenting. The late clinical outcome, however, is still uncertain after stenting with high pressure balloon dilation. Therefore, we evaluated the effect of high pressure balloon dilation on subsequent clinical courses after intracoronary stenting. METHOD: One hundred sixty nine patients with 176 lesions were treated with Palmaz-Schatz stent implantation. Intracoronary stenting without high pressure balloon dilation was perforned in 55 patients with 55 lesions(phase 1), whereas intracoronary stenting with high pressure balloon dilation was done in 114 patients with 121 lesions(phase 2). We compared the angiographic and clinical results immediately and at late follow-up period after atenting between phase 1 and phase 2. RESULTS: Coronary angiography was repeated at 6 months in 135 patients, 138 lesions(78%). The overall incidence of restenosis was 25%(31% in phase 1 and 22% in phase 2). The restenosis occurred in 18% of elective stenting on de novo lesions(23% in phase 1 and 15% in phase 2). The restenosis rate was significantly reduced after using high pressure balloon dilation in infarct-related artery, final luminal diameter>/=4.0 mm after stenting and bail-out procedure(p<0.05). In phase 2, the restenosis rate was significantly higher in the lesions that had been previously dilated(43% in restenotic lesion vs 15% in de novo lesion, p<0.05) and in type C lesion compared with the others(type A, type B1, type B2 and type C ; 22%, 22%, 15% and 57%, respectively, p<0.05). According to the final luminal diameter, the restenosis rate was 7% in case of final luminal diameter greater than 4.0 mm which was significantly lower than that of final luminal diameter less than 3.5mm(p<0.05). At univariate anaysis, factors affecting restnosis were post-stent minimal luminal diameter, balloon-to-vessel ratio, acute gain and restenotic lesion. However multivariate analysis showed post-stent minimal luminal diameter was the only factor affecting restenosis. CONCLUSION: As intracoronary stenting using high pressure balloon dilation technique without anticoagulation has a good immediate results, negligible stent thrombosis and has a tendency of lower rate of restenosis.
Angioplasty, Balloon ; Arteries ; Coronary Angiography ; Coronary Artery Disease ; Dilatation* ; Follow-Up Studies ; Humans ; Incidence ; Multivariate Analysis ; Phenobarbital ; Stents* ; Thrombosis