Syphilitic coronary artery ostial stenosis resulting in acute myocardial infarction treated by percutaneous coronary intervention

Cardiovascular syphilis-associated acute myocardial infarction: A case report

RATIONALE

In recent decades, the incidence of advanced syphilis has declined due to early recognition and the application of effective antibiotics. Advanced syphilis often manifests in the cardiovascular system as simple aortitis, aortic valve insufficiency, coronary artery stenosis or obstruction, Aortic aneurysm and mucinous myocarditis. In most case reports on the subject, acute myocardial infarction caused by syphilis was reported to be due to aortic valve insufficiency and coronary stenosis as a result of the involvement of the aorta.

PATIENT CONCERNS

The patient was a 48-year-old woman. She was admitted to our hospital because of intermittent upper abdominal pain with chest tightness for 3 hours. The patient reported a past syphilis infection, when she was hospitalized for hysteromyoma surgery four years ago, and had no related treatment.

DIAGNOSIS

According to the characteristics of coronary angiography and results of lab tests and echocardiography, she was finally diagnosed with myocardial infarction associated with syphilis.

INTERVENTIONS

At the first diagnosis of syphilis, the patient did not received antibiotics treatment. After the diagnosis of myocardial infarction, she received the percutaneous coronary intervention (PCI) operation assisted by extracorporeal membrane oxygenation (ECMO) technology, successfully got drug -eluted stents in right coronary artery ostium and left main ostium. Then the patient received penicillin to treat the syphilis infection.

OUTCOMES

After coronary revascularization, the cardiac function of the patients was gradually improved, and the left ventricular ejection fraction was gradually improved after combined with optimized drug therapy.

LESSONS

The cardiovascular system is often involved in the stages of advanced syphilis with severe complications like myocardial infarction. Standard treatment should be given as soon as syphilis is diagnosis. For stenosis of coronary ostium, the PCI assisted by ECMO technology did not only ensure the effectiveness of the treatment, but also reduce the surgical risk of the patient. This case indicated the effectiveness of ECMO-assisted PCI, and thus may provide a reference for future patient treatment.

Comparison of coronary artery bypass grafting and percutaneous coronary intervention for syphilitic coronary artery ostial lesions: A 4-year retrospective study

This study investigated the efficacy of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in treatment of patients with syphilitic coronary artery ostial lesions (SCAOL).Sixty SCAOL patients were divided into two groups according to the different treatments: the CABG group (n = 32) and the PCI group (n = 28). We determined serum levels of β-type natriuretic peptide (BNP) and cardiac function, and evaluated treatment efficacy such as the rates of restenosis, patency, and major adverse cardiovascular events (MACEs) during hospital stay and the effects of antisyphilis and different types of CABG on restenosis during the 6-month follow-up period.There were no statistical differences in demographic or baseline clinical characteristics, BNP levels, left ventricular end-diastolic diameter (LVDd), or ejection fraction (EF) between the CABG and PCI groups at 1 week after surgery, However, after 6-month of follow-up, the CABG group had a significantly lower rate of coronary artery restenosis, lower incidence of MACEs, and better cardiac function than the PCI group. Within the CABG group, the left internal mammary artery (LIMA) subgroup had a lower restenosis rate than the saphenous vein graft (SVG) subgroup. In addition, patients who had received anti-syphilis therapy had a significantly lower restenosis rate than those without anti-syphilis therapy at 6-month post-surgery.Compared with patients who received PCI, patients who received CABG had better prognoses. LIMA has a better therapeutic efficacy than SVG in terms of the restenosis rate, and anti-syphilis treatment significantly reduces the restenosis rate, compared with non-anti-syphilis treatment.

Syphilitic coronary artery ostial stenosis resulting in acute myocardial infarction

Cardiovascular abnormalities are well-known manifestations of a late form of syphilis - tertiary syphilis. Since the era of antibiotics, the incidence of late manifestations of syphilis has declined almost to a rare entity. The injury of aorta (the aortitis with a dilatation of aortic root and its associated complications) is the most common between all the cardiovascular lesions. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We present the case of a 37-year-old male who was treated for an acute myocardial infarction due to bilateral coronary artery ostial stenosis secondary to syphilitic aortitis. According to the multidisciplinary decision, surgical revascularization (coronary artery bypass grafting, CABG) was performed. According to dermatologist recommendation, patient postoperative cardiovascular treatment was supplemented with intramuscular doses of benzathine penicillin recommended for tertiary syphilis. Further follow-up visits were also planned to detect possible changes of the aortic wall, dynamics of aortic regurgitation or potential anastomotic restenosis due to progression of aortitis.

Aneurysm and dissection in a patient with syphilitic aortitis

In the antibiotic era, aortic aneurysm is a rare complication of syphilis, what makes the diagnostic assumption even more difficult. Nonetheless, this condition should be suspected in patients with aortic aneurysm. Reports of aortic dissection complicating syphilitic aortitis have been distinctly rare in the literature, and their cause-effect relationship has not been definitely established. In this case report, we present a 62-year-old woman with aortic aneurysm and dissection associated with an unexpected diagnosis of syphilitic aortitis.