Coronary Ostial Stenosis in a Young Patient (original) (raw)

Abstract

The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/

Figures (3)

At surgery, the ascending aorta had a hyperemic, inflamma- tory adventitia that adhered firmly to the surrounding structures. Cross-clamping revealed a markedly thickened wall, with exten- sive longitudinal wrinkling all the way into the aortic root, deforming and narrowing the coronary ostia (Figure 2). The aortic valve leaflets were thickened and retracted, resulting in severe, central incompetence. Aortic valve replacement with a 25-mm mechanical prosthesis and a triple total arterial coronary bypass with the use of the radial and both internal thoracic 37-year-old man presented to our department complaining of severe chest pain triggered by the slightest physical exercise. The symptoms appeared 6 months previously and have gradually worsened. His medical history was unremarkable, and he had no cardiovascular risk factors except smoking. A 6-lead ECG at rest was normal, as was the chest x-ray. The ultrasonog- raphy examination revealed severe aortic regurgitation and a moderately enlarged left ventricle with normal systolic function. The treadmill test was positive for myocardial ischemia. He subsequently underwent a catheter examination that diagnosed severe right and left main coronary ostial stenoses along with severe aortic valve incompetence (Figure 1A and 1B). A computed fomographic examination confirmed these findings (Figure 1C and

At surgery, the ascending aorta had a hyperemic, inflamma- tory adventitia that adhered firmly to the surrounding structures. Cross-clamping revealed a markedly thickened wall, with exten- sive longitudinal wrinkling all the way into the aortic root, deforming and narrowing the coronary ostia (Figure 2). The aortic valve leaflets were thickened and retracted, resulting in severe, central incompetence. Aortic valve replacement with a 25-mm mechanical prosthesis and a triple total arterial coronary bypass with the use of the radial and both internal thoracic 37-year-old man presented to our department complaining of severe chest pain triggered by the slightest physical exercise. The symptoms appeared 6 months previously and have gradually worsened. His medical history was unremarkable, and he had no cardiovascular risk factors except smoking. A 6-lead ECG at rest was normal, as was the chest x-ray. The ultrasonog- raphy examination revealed severe aortic regurgitation and a moderately enlarged left ventricle with normal systolic function. The treadmill test was positive for myocardial ischemia. He subsequently underwent a catheter examination that diagnosed severe right and left main coronary ostial stenoses along with severe aortic valve incompetence (Figure 1A and 1B). A computed fomographic examination confirmed these findings (Figure 1C and

Figure 2. Intraoperative view of the ascending aorta. Tree barking of the intima and fibrosis and retraction of the aortic cusps are shown.

Figure 2. Intraoperative view of the ascending aorta. Tree barking of the intima and fibrosis and retraction of the aortic cusps are shown.

Figure 3. A, Chronic lymphocytic and plasmacytic inflammatory infiltrate of the medial layer with disruption of the elastic fibers (Masson’s trichrome stain). B, Endarteritis obliterans of the vasa vasorum (Masson’s trichrome stain, magnification 200). arteries was performed. The pathological examination revealed endarteritis obliterans of the vasa vasorum, a chronic inflamma- tory infiltrate in the medial layer with disruption of the elastic fibers, and a severely thickened intima (Figure 3A and 3B). See the online-only Data Supplement for additional information. A

Figure 3. A, Chronic lymphocytic and plasmacytic inflammatory infiltrate of the medial layer with disruption of the elastic fibers (Masson’s trichrome stain). B, Endarteritis obliterans of the vasa vasorum (Masson’s trichrome stain, magnification 200). arteries was performed. The pathological examination revealed endarteritis obliterans of the vasa vasorum, a chronic inflamma- tory infiltrate in the medial layer with disruption of the elastic fibers, and a severely thickened intima (Figure 3A and 3B). See the online-only Data Supplement for additional information. A

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