Monica A Isabella1, Carol Langford2, Alison Clifford3 and Eric E Roselli4,5*
1Departments of General Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA
2Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio 44195, USA
3Department of Biological Sciences, University of Alberta, Edmonton, Alberta T6G 2E9, USA
4Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
5Aortic Center, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
When confronted with an aortic root aneurysm in a young patient, one of the most common etiologies is a connective tissue disorder (CTD, such as Marfan’s, Loeys Dietz, and Ehlers-Danlos.) Aortitis is considered rare among young patients and can be easily missed in asymptomatic cases. Aortitis can be difficult to diagnose but is important to investigate during surgery because missing the diagnosis may affect late outcomes. Undertreated aortitis may progress beyond the treated segment. Our understanding of arteritis is improving, and it has been suggested that Giant Cell Arteritis (GCA) and Takayasu Arteritis (TAK) may represent an overlapping spectrum of disease. CTD, GCA, and TAK require lifelong surveillance and immunosuppressive treatment for active disease. However, Autoimmune Aortitis may be cured surgically. We describe two patients in their twenties with aortic root aneurysms who underwent valve sparing aortic root replacement. Both were found on histologic examination to have chronic aortitis. The cases presented here demonstrate the importance for surgeons to send aortic specimens for histologic review when performing aortic aneurysm repair.
Aorta; Aneurysm (Root); Histology (Aortic); Pathology (Aortic); Surgery
Isabella MA, Langford C, Clifford A, Roselli EE. Aortic Root Aneurysms in Twenty-Year-Olds: Don't Forget to Check the Histology. Clin Surg. 2017; 2: 1472.