Unusual blue discolouration of the ascending aorta in a patient with Churg–Strauss syndrome undergoing surgical aortic valve replacement: a case report

Churg-Strauss syndrome (eosinophilic granulomatosis with polyangiitis) is a rare systemic vasculitis that predominantly affects small- to medium-sized vessels, with large-vessel involvement being exceptional. We report a 72-year-old woman with Churg-Strauss syndrome and severe low-flow, low-gradient aortic stenosis (left ventricular ejection fraction 15%) who underwent surgical aortic valve replacement following multidisciplinary Heart Team assessment. Intraoperatively, an unusual blue discolouration of the ascending aortic intima was observed. Postoperatively, the patient developed cardiac tamponade requiring urgent reintervention and had a prolonged recovery before being discharged to rehabilitation. This case expands the spectrum of vascular manifestations in Churg-Strauss syndrome and highlights potential perioperative challenges during cardiac surgery.