Myocardial dissection complicating left sinus of Valsalva aneurysm in silent takayasu arteritis

• Published in: BMC cardiovascular disorders 2021-09, Vol.21 (1), p.464-7, Article 464
• Main Authors: Astuti, Astri, Kartamihardja, Achmad Hafiedz Azis, Ilhamy, Muhammad Adniel, Fahlavi, Muhammad Dinnar, Kusumawardhani, Nuraini Yasmin, Hasan, Melawati, Hamijoyo, Laniyati
• Format: Article
• Language: English
• Subjects: Abdomen; Adult; Aneurysm; Aneurysms; Angiography; Aorta; Aortic Aneurysm - complications; Aortic Aneurysm - diagnostic imaging; Aortic Aneurysm - drug therapy; Aortic Dissection - diagnostic imaging; Aortic Dissection - drug therapy; Aortic Dissection - etiology; Arteritis; Autoimmune diseases; Azathioprine; Azathioprine - therapeutic use; Beta blockers; Calcification; Cardiomyopathy; Cardiomyopathy, Dilated - complications; Cardiomyopathy, Dilated - diagnostic imaging; Cardiomyopathy, Dilated - drug therapy; Carotid arteries; Case Report; Case studies; Complications and side effects; Computed tomography; Congenital diseases; Congestive heart failure; Coronary vessels; Cysts; Diagnosis; Dilated cardiomyopathy; Disease; Dissection; Dyspnea; Enzymes; Etiology; Fainting; Heart diseases; Heart failure; Heart rate; HIV; Human immunodeficiency virus; Humans; Hypertension; Immunosuppressive Agents - therapeutic use; Infections; Inflammation; Ischemia; Left sinus of Valsalva aneurysm; Male; Marfan syndrome; Medical imaging; Medical treatment; Myocardial dissection; Myocardium - pathology; Patients; Respiration; Risk factors; Sinus of Valsalva - diagnostic imaging; Steroids - therapeutic use; Surgery; Syphilis; Takayasu arteritis; Takayasu Arteritis - complications; Takayasu Arteritis - diagnostic imaging; Takayasu Arteritis - drug therapy; Takayasu's arteritis; Takayasu's disease; Treatment Outcome; Ultrasonic imaging; Veins & arteries
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-021-02271-4

Myocardial dissection (MD) in a left sinus of Valsalva aneurysm (LSVA) is a rare condition that may lead to a fatal complication. Determining the MD etiology is challenging because of various possibilities ranging from congenital to acquired diseases. Here, we discuss an approach for determining the etiology of MD complicating LSVA in Takayasu arteritis (TA) and its treatment. A 41-year-old man presented with dyspnea on heavy activities and a history of consciousness loss at the age of 24 years. He was diagnosed with dilated cardiomyopathy and MD complicating LSVA in TA based on combined clinical and pathognomonic diagnostic criteria of TA evaluated using vascular Doppler and computed tomography angiography of the aorta. The patient refused to undergo surgery and received an optimal dose of chronic heart failure therapy, a high-dose steroid, and azathioprine. The patient experienced some improvements in clinical condition, functional outcome, and inflammatory markers at 1-year follow-up. Clinical criteria and various imaging modalities may be used to determine the etiology of MD complicating LSVA in silent TA. As an alternative to surgery, the optimal medical treatment might result in a satisfactory outcome.