左冠状動脈入口部狭窄を伴う梅毒性大動脈瘤切迫破裂に対し緊急手術を施行した1例

Emergency Operation for Impending Rupture of Syphilitic Aortic Aneurysm with Left Coronary Ostial Stenosis：Report of a Case

はじめに　心血管梅毒はTreponema palli­dumへの初感染から約15～30年後の第三期の梅毒に認められる合併症であり，その中でも梅毒性大動脈炎は大動脈瘤や大動脈弁閉鎖不全症，冠状動脈狭窄などを引き起こす．

Syphilis is known as a cause of syphilitic aortitis. Chronic inflammation leads to formation of syphilitic aneurysm which often is found at the ascending aorta. If the inflammation spreads to the aortic root, stenosis of coronary ostium or aortic valve regurgitation are caused. We report a case that impending rupture of syphilitic aneurysm at ascending aorta with stenosis of left coronary ostium. The patient is a 49 years old male, and his chief complaint was chest pain which gradually became stronger. Computed tomography （CT） identified a large ascending aneurysm with a maximum diameter of 66 mm. The serum rapid plasma regain （RPR） test and the fixed Treponema pallidum latex agglutination （TPLA） test were positive. We diagnosed impending rupture of aneurysm, and performed emergency ascending aorta replacement. The aortic aneurysm was strongly adherent to the surrounding tissues. Pathological findings showed mesaortitis, which was consistent with syphilitic aneurysm. We started oral administration of amoxicillin hydrate from postoperative day 8. The patient did well, and was discharged on postoperative day 18. During his hospitalization, we performed enhanced coronary CT, and found stenosis of left coronary ostium. But he had no symptoms, so he got percutaneous coronary intervention after his discharge. Now the number of patients of syphilis is increasing in Japan. So it is important to know its characteristics and proper treatment.