Aortic Insufficiency Associated with Aortitis Syndrome

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Abstract
Aortic insufficiency was found in 9 of 44 cases of aortitis syndrome seen during 8 years, representing a high incidence (20%), previously unreported. These consisted of 2 men and 7 women, ranging in age from 21 to 68. Two which developed congestive heart failure died. Blood pressure in the diseased extremity lacked the characteristic peripheral signs of aortic insufficiency. X-ray films of the chest showed cardiac enlargement, dilatation of the ascending aorta and calcification of the aortic wall. Ecg showed left ventricular hypertrophy and phonocardiogram showed diastolic decrescendo murmur in the Erb''s area. Retrograde aortography showed dilatation of the ascending aorta. Distribution of the aortitis included at least an involvement of the aortic arch. Etiological classification of 205 cases of aortic insufficiency revealed unexpectedly high incidence of aortitis syndrome, which occupied 4th place following rheumatic, syphilitic and hyper tensive causes. Thirty-one similar cases collected from previous and present reports were reviewed. Pathology of the disease revealed dilatation of the ascending aorta, and destruction of the medial elastic fibers. Mechanism of producing aortic insufficiency in the aortitis syndrome was discussed. High incidence of aortic insufficiency among the cases of aortitis syndrome, frequent occurrence of aortic insufficiency in other types of aortitis and finally the pathological findings strongly indicated that dilatation of the aortic ring due to aortitis involving the ascending aorta is the primary cause of aortic insufficiency.