Sifilitik Aortit
Özet
Treponema pallidum'un neden olduğu sifilitik aortit, prevalansı azalmış olsa da önemli bir klinik varlık olarak kalmaktadır. Bu spiroket, aort duvarını invaze eder ve aort duvarının kas ve elastik liflerinin nekrozuna ve obliteratif endarterite yol açan inflamatuar bir yanıt oluşturur. Sonuç olarak, aort anevrizması, aort kapak yetmezliği, aort kökü dilatasyonu ve koroner ostial stenoz gibi ciddi komplikasyonlar ortaya çıkabilir. Tarihsel olarak, kardiyovasküler sifiliz 20. yüzyılın başlarında yaygındı ve çalışmalarda önemli insidanslar bildirilmiştir. Erkeklerde ve düşük sosyoekonomik gruplarda daha yaygındır. Hastalık süreci genellikle bakterilerin hematogen yayılımıyla başlar, inflamatuar değişikliklere, adventisyal skarlaşmaya ve yamalı medial nekroza yol açar. Asimptomatik aortit, en yaygın form olmasına rağmen reaktif serolojik bulguların veya karakteristik radyografik özelliklerin olmaması nedeniyle tanısal zorluklar sunar. Aort anevrizması, daha az yaygın olmakla birlikte, sifilitik aortitin kritik bir belirtisini temsil eder. Standart tedavi, cerrahi müdahale ve penisilin ile antibiyotik tedavisini içerir ve bu, geç dönem sifilizin morbidite ve mortalitesini önemli ölçüde azaltmıştır. Tedavi edilmeyen sifilitik anevrizmalar kötü prognoza sahiptir ve 2 yıllık mortalite oranı %80'in üzerindedir. Sonuç olarak, tersiyer sifiliz ağırlıklı olarak asendan aortayı etkiler ve belirgin bir etiyoloji olmaksızın asendan aort anevrizması olan hastalarda sifiliz ayırıcı tanıda düşünülmelidir.
Syphilitic aortitis, caused by Treponema pallidum, remains a significant clinical entity despite its decreased prevalence. This spirochete invades the aortic wall, inducing an inflammatory response that leads to obliterative endarteritis and necrosis of the aortic wall's muscular and elastic layers. Consequently, severe complications such as aortic aneurysm, aortic valve insufficiency, aortic root dilation, and coronary ostial stenosis can occur. Historically, cardiovascular syphilis was prevalent in the early 20th century, with studies reporting significant incidences. It is more common among males and individuals from lower socioeconomic backgrounds. The disease process typically begins with the hematogenous spread of the bacteria, resulting in inflammatory changes, adventitial scarring, and patchy medial necrosis. Asymptomatic aortitis, although the most common form, poses diagnostic challenges due to the lack of reactive serological findings or characteristic radiographic features. Aortic aneurysm, though less common, represents a critical manifestation of syphilitic aortitis. The standard treatment includes surgical intervention and antibiotic therapy with penicillin, which has significantly reduced the morbidity and mortality associated with late-stage syphilis. Untreated syphilitic aneurysms have a poor prognosis, with a 2-year mortality rate exceeding 80%. In conclusion, tertiary syphilis primarily affects the ascending aorta, and syphilis should be considered in the differential diagnosis for patients presenting with ascending aortic aneurysms without an apparent etiology.
Referanslar
Welty JW: A necropsy study of cardiovascular syphilis with particular reference to its decreasing incidence. Am J Med Sci 1939; 197: 782-793.
Heggtveit HA: Syphilitic aortitis. Circulation 1964; 29: 346-355.
Kampmeier RH, Morgan H J: The specific treatment of syphilitic aortitis. Circulation 952; 5: 771-778.
Holmes KK, Lukehart SA: Syphilis. In: Braunwald E, Isselbacher K J, Petersdorf RG, Wilson JD, Martin JB, Fauci AS, eds. Harrison's principles of internal medicine, l lth ed. New York: McGraw-Hill, 1987; 639-649.
Schatzki R: Discussion of Cabot case 28271. N Engl J Med 1942; 227: 22-26.
Jackman J, Lubert M: The significance of calcification in the ascending aorta as observed roentgenologically. A JR 1945; 53: 432-438.
Leighton RS: Calcification of the ascending aorta as a sign of syphilitic aortitis. Radiology 1948; 5]: 257-258.
Thorner MC, Carter RA, Griffith GC: Calcification as a diagnostic sign of syphilitic aortitis. Am Heart J 1949; 38: 641-653.
McCann JS, Porter DC: Calcification of the aorta as an aid to the diagnosis of syphilis, Br Med J ]956; I: 826-827
Bahnson HT: Thoracic aneurysms. In: Sabiston DC, Spencer FC, eds. Gibbon's surgery of the chest, 4th ed. Philadelphia: WB Saunders, 1983; 967-976.
Jaffe H: Management of reactive serology. In: Holmes KK, Mardh P, Sparling PF, Weisner P J, eds. Sexually transmitted diseases. New York: McGraw-Hill, 1984; 313-318.
Kampmeier RH: Saccular aneurysms of the thoracic aorta: a clinical study of 633 cases. Ann Intern Med 1938; 12: 624-651.
Boyd U: A study of four thousand reported cases of aneurysms of the thoracic aorta. Am J Med Sci 1924; 168: 654-668.
Halpert B, Willms RK: Aneurysms of the aorta: an analysis of 249 necropsies. Arch Pathol 1962; 74: 163-168.
Jones AM, Langley FA: Aortic sinus aneurysms. Br Heart J 1949; i ]: 325-341
Maleszewski JJ. Inflammatory ascending aortic disease: perspectives from pathology. J Thorac Cardiovasc Surg. 2015;149(2 Suppl):S176-83.
Kouchoukos NT, Karp RB, Blackstone EH, Kirklin JW, Pacifico AD, Zorn GL: Replacement of the ascending aorta and aortic valve with a composite graft: results in 86 patients. Ann Surg 1980: 192: 403-412.
Crawford ES, Vaccarro PS: Aneurysms of the transverse aortic arch. In: Bergan J J, Yao JST, eds. Aneurysms, diagnosis and treatment. New York: Grune and Stratton, 1982; 131-150.
Crawford ES, Walker HSJ III, Saleh SA, Normann NA: Graft replacement of aneurysms in descending thoracic aorta: results without bypass or shunting. Surgery 1981; 89: 73-84
St John RK: Treatment of cardiovascular syphilis. J Am Vener Dis Assoc 1976; 3: 148-152.
Edeiken J, Ford WT, Falk MS: Further observations on penicillin-treated cardiovascular syphilis. Circulation 1952; 6: 267-275.
Isbir S, Hamidov A, Seven IE, Ak K. Massive hemoptysis related to contained rupture of syphilitic aortic aneurysm into the pulmonary parenchyma. J Thorac Cardiovasc Surg. 2017;154:e23-5.
Referanslar
Welty JW: A necropsy study of cardiovascular syphilis with particular reference to its decreasing incidence. Am J Med Sci 1939; 197: 782-793.
Heggtveit HA: Syphilitic aortitis. Circulation 1964; 29: 346-355.
Kampmeier RH, Morgan H J: The specific treatment of syphilitic aortitis. Circulation 952; 5: 771-778.
Holmes KK, Lukehart SA: Syphilis. In: Braunwald E, Isselbacher K J, Petersdorf RG, Wilson JD, Martin JB, Fauci AS, eds. Harrison's principles of internal medicine, l lth ed. New York: McGraw-Hill, 1987; 639-649.
Schatzki R: Discussion of Cabot case 28271. N Engl J Med 1942; 227: 22-26.
Jackman J, Lubert M: The significance of calcification in the ascending aorta as observed roentgenologically. A JR 1945; 53: 432-438.
Leighton RS: Calcification of the ascending aorta as a sign of syphilitic aortitis. Radiology 1948; 5]: 257-258.
Thorner MC, Carter RA, Griffith GC: Calcification as a diagnostic sign of syphilitic aortitis. Am Heart J 1949; 38: 641-653.
McCann JS, Porter DC: Calcification of the aorta as an aid to the diagnosis of syphilis, Br Med J ]956; I: 826-827
Bahnson HT: Thoracic aneurysms. In: Sabiston DC, Spencer FC, eds. Gibbon's surgery of the chest, 4th ed. Philadelphia: WB Saunders, 1983; 967-976.
Jaffe H: Management of reactive serology. In: Holmes KK, Mardh P, Sparling PF, Weisner P J, eds. Sexually transmitted diseases. New York: McGraw-Hill, 1984; 313-318.
Kampmeier RH: Saccular aneurysms of the thoracic aorta: a clinical study of 633 cases. Ann Intern Med 1938; 12: 624-651.
Boyd U: A study of four thousand reported cases of aneurysms of the thoracic aorta. Am J Med Sci 1924; 168: 654-668.
Halpert B, Willms RK: Aneurysms of the aorta: an analysis of 249 necropsies. Arch Pathol 1962; 74: 163-168.
Jones AM, Langley FA: Aortic sinus aneurysms. Br Heart J 1949; i ]: 325-341
Maleszewski JJ. Inflammatory ascending aortic disease: perspectives from pathology. J Thorac Cardiovasc Surg. 2015;149(2 Suppl):S176-83.
Kouchoukos NT, Karp RB, Blackstone EH, Kirklin JW, Pacifico AD, Zorn GL: Replacement of the ascending aorta and aortic valve with a composite graft: results in 86 patients. Ann Surg 1980: 192: 403-412.
Crawford ES, Vaccarro PS: Aneurysms of the transverse aortic arch. In: Bergan J J, Yao JST, eds. Aneurysms, diagnosis and treatment. New York: Grune and Stratton, 1982; 131-150.
Crawford ES, Walker HSJ III, Saleh SA, Normann NA: Graft replacement of aneurysms in descending thoracic aorta: results without bypass or shunting. Surgery 1981; 89: 73-84
St John RK: Treatment of cardiovascular syphilis. J Am Vener Dis Assoc 1976; 3: 148-152.
Edeiken J, Ford WT, Falk MS: Further observations on penicillin-treated cardiovascular syphilis. Circulation 1952; 6: 267-275.
Isbir S, Hamidov A, Seven IE, Ak K. Massive hemoptysis related to contained rupture of syphilitic aortic aneurysm into the pulmonary parenchyma. J Thorac Cardiovasc Surg. 2017;154:e23-5.
