Aortic Root Aneurysms in Twenty-Year-Olds: Don't Forget to Check the Histology

Monica A Isabella, Carol Langford, Alison Clifford and Eric E Roselli

Departments of General Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA
Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio 44195, USA
Department of Biological Sciences, University of Alberta, Edmonton, Alberta T6G 2E9, USA
Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
Aortic Center, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA

^*Correspondance to: Eric E Roselli 

 PDF  Full Text DOI: 10.25107/2474-1647.1472

Abstract

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.

Keywords

Aorta; Aneurysm (Root); Histology (Aortic); Pathology (Aortic); Surgery

Cite the article

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.