Takayasu Arteritis: new trends in surgical approach – case presentation

Abstract

Takayasu arteritis (TA) is defined as a rare chronic granulomatous panarteritis that classically involves segments of large arteries such as the aortic arch. The aim of this report is to present our recent experience in diagnosis and treatment of TA and to provide aspects of surgical strategy for inflammatory aneurysms caused by TA. We present the case of a 36-year-old Caucasian female admitted to our clinic with low effort dyspnea, fatigability, palpitations, sweats, malaise and light-headedness. The medical history revealed a history of treated tuberculosis, anemia, arterial hypertension, chronic inflammatory syndrome, aortic insufficiency, and anterior mitral valve prolapse. Echocardiography revealed grade III-IV aortic regurgitation, grade I-II mitral regurgitation, a dilated ascending aorta and mild systolic dysfunction. CT angiography revealed an aneurysmal dilatation of the ascending aorta. Surgical treatment was mandatory, and intraoperative, the surgeon noted a diffuse thickening of the aortic wall and suspected TA, further confirmed by histopathological examination. The tricuspid aortic valve was excised and a composite graft with a biological valve and an aortic conduit were implanted on patient’s request. Postoperative course was uneventful and the patient was discharged from the hospital on the 10th postoperative day, and directed towards Rheumatology Clinic for medical treatment. A multidisciplinary approach to the diagnosis and management of TA patients is essential to a satisfactory outcome.