Aortic Insufficiency Associated with Aortitis Syndrome

Aortic insufficiency was found in 9 of 44 cases of aortitis syndrome seen during 8 years, representing a high incidence (20%), unreported previously. They consisted of 2 men and 7 women, ranging in age from 21 to 68. Two cases 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. Electrocardiogram showed left ventricular hypertrophy and phonocardiogram showed diastolic decreascendo murmur in the Erb's area. Retrograde aortography showed dilatation of the ascending aorta. Distribution of the aortitis included at least an involvement of aortic arch. Etiological classification of 205 cases of aortic insufficiency revealed unexpectedly high incidence of aortitis syndrome, which occupied the fourth place following rheumatic (112), syphilitic (32) and hypertensive (25) nature.Thirty-one similar cases were collected from the previous and the present reports and 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.