Department of Cardiology and Vascular Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Jl. Pasteur no.38, Bandung, West Java, Indonesia.
Division of Rheumatology, Department of Internal Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia.
BMC Cardiovasc Disord. 2021 Sep 26;21(1):464. 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.
左冠状动脉窦瘤（LSVA）中的心肌夹层（MD）是一种罕见的疾病，可能导致致命的并发症。由于先天性和获得性疾病等各种可能性，确定 MD 的病因具有挑战性。在这里，我们讨论了一种用于确定 Takayasu 动脉炎（TA）并发 LSVA 的 MD 病因及其治疗的方法。
一名 41 岁男性，因剧烈活动时呼吸困难和 24 岁时意识丧失就诊。根据 TA 的综合临床和特征性诊断标准，结合血管多普勒和主动脉计算机断层血管造影评估，患者被诊断为扩张型心肌病和 TA 并发 LSVA 的 MD。患者拒绝手术，接受了慢性心力衰竭治疗的最佳剂量、大剂量类固醇和硫唑嘌呤。在 1 年随访时，患者的临床状况、功能结局和炎症标志物有所改善。
临床标准和各种成像方式可用于确定沉默型 TA 并发 LSVA 的 MD 的病因。作为手术的替代方法，最佳的药物治疗可能会产生满意的结果。
