Lone Aortic Insufficiency and Conduction Disease: A Marker of Reactive Arthritis

• Published in: Echocardiography (Mount Kisco, N.Y.) N.Y.), 2014-10, Vol.31 (9), p.E271-E274
• Main Authors: Lader, Joshua M., Lam, Geoffrey, Donnino, Robert, Katz, Edward S., DeAnda, Abe, Ettel, Mark, Saric, Muhamed
• Format: Article
• Language: English
• Subjects: aortic insufficiency; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Insufficiency - complications; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - surgery; Arthritis, Reactive - blood; Arthritis, Reactive - complications; Arthritis, Reactive - diagnosis; Atrioventricular Block - complications; Atrioventricular Block - diagnosis; Biomarkers - blood; Echocardiography, Transesophageal - methods; Electrocardiography - methods; Heart Valve Prosthesis; HLA-B27 Antigen - blood; HLA‐B27; Humans; Male; Middle Aged; reactive arthritis; Reiter's syndrome
• ISSN: 0742-2822; 1540-8175
• DOI: 10.1111/echo.12691

A 48‐year‐old male with history of chronic arthritis and uveitis presented with 1 year of progressively reduced exercise capacity and nonexertional chest pain. Physical examination was consistent with severe aortic insufficiency. An electrocardiogram demonstrated sinus rhythm with first degree atrioventricular block. Transthoracic and transesophageal echocardiography demonstrated severe lone central aortic insufficiency of a trileaflet valve due to leaflet thickening, retraction of leaflet margins and mild aortic root dilation in the setting of left ventricular dilatation. In addition, computed tomographic angiography revealed a small focal aneurysm of the distal transverse arch. He was found to be positive for the immunogenetic marker HLA‐B27. The patient subsequently underwent uncomplicated mechanical aortic valve replacement. The diagnosis of HLA‐B27 associated cardiac disease should be entertained in any individual with lone aortic insufficiency, especially if accompanied by conduction disease. Mini‐ We report the case of a 48‐year‐old man with chronic reactive arthritis (previously referred to as the Reiter's syndrome) who presented with a heart failure syndrome due to severe lone aortic insufficiency. The case demonstrates multimodality imaging of the classic cardiac findings associated with the immunogenetic marker HLA‐B27.