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J Thorac Cardiovasc Surg 2008;135:440-441
© 2008 The American Association for Thoracic Surgery

Brief Communication

Rare presentation of Takayasu's aortoarteritis after double valve replacement

Shivanand Gangahanumaiah, MCha,*, Vijayakumar Raju, MSa, Ram Kumar Jayavelan, MCha, Alpha Mathew Kavunkal, MCha, Vijit Koshy Cherian, MCha, Debashish Danda, DMb, Velayudhan V. Bashi, MChc

a Department of Cardiothoracic Surgery, Christian Medical College and Hospital, Vellore, India
b Department of Rheumatology, Christian Medical College and Hospital, Vellore, India
c Department of Cardiothoracic Surgery, MIOT Hospital, Chennai, India

Received for publication August 31, 2007; accepted for publication October 19, 2007.

* Address for reprints: Shivanand Gangahanumaiah, MCh, Department of Cardiothoracic Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004, India. (Email: cardiothoracic1@cmcvellore.ac.in).

The first 20% of the full text of this article appears below.


Figure 1
Drs Kavunkal, Ramkumar, Ganguhanumaiah, and Raju (standing, left to right); Drs Bashi and Cherian (seated, left to right)


Takayasu's aortoarteritis is a chronic inflammatory disease involving the aorta, arteries arising from the aorta, and, frequently, the pulmonary arteries. The inflammation leads to either stenosis and occlusion of the involved artery, aneurysm formation, or both.1Go We report a rare case of evolving Takayasu's aortoarteritis diagnosed after double valve replacement. A similar presentation has not been reported earlier.

Clinical Summary

A 29-year-old woman presented with dyspnea on exertion that progressed to New York Heart Association class IV over a period of 1 month. She gave no history suggestive of rheumatic fever. Echocardiographic analysis revealed severe mitral regurgitation, moderate aortic regurgitation, and pulmonary hypertension with good left ventricular function. She presented with features of congestive cardiac failure. She was hospitalized on 2 previous occasions for congestive cardiac failure. The C-reactive protein level was 121 mg/L, the antistreptolysin-O titer was 250 IU/mL, and the erythrocyte sedimentation rate was 35 mm/h. Chest roentgenographic study showed cardiomegaly (cardiothoracic ratio of 62%) with biatrial enlargement and pulmonary venous hypertension. Investigations for other inflammatory markers, such as circulating antineutrophil cytoplasmic antibody (C-ANCA), perinuclear P-ANCA, and antinuclear antibody (ANA), were negative. She was started on intravenous frusemide and oral aspirin, despite which she continued to be in refractory cardiac failure. In view of her symptoms, she was sent for early . . . [Full Text of this Article]






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