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Childhood-onset Takayasu arteritis and immunodeficiency: case-based review. Clin Rheumatol 2022; 41:2883-2892. [PMID: 35854168 DOI: 10.1007/s10067-022-06295-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 11/03/2022]
Abstract
Takayasu arteritis (TAK) has been rarely reported in patients with immunodeficiency. In this review, we present two cases with childhood-onset TAK (c-TAK) and primary immunodeficiency while reviewing similar cases in the literature. We reviewed the data for our two pediatric patients with c-TAK and primary immunodeficiency. We also reviewed the literature for patients with c-TAK and immunodeficiency from the inceptions of the databases up to November 2021. A 14-year-old patient had lipopolysaccharide-sensitive beige-like anchor (LRBA) deficiency, and a 16-year-old had X-linked severe combined immunodeficiency (X-linked SCID). During the follow-up, they developed findings suggestive of vasculitides such as hypertension, elevation in acute phase reactants, weakness, and weight loss. Thoracoabdominal computed tomography angiography revealed findings consistent with vasculitis involving the aorta and its major branches. Patients were diagnosed with c-TAK, and corticosteroids were given to both patients in the treatment. We identified 11 articles describing 17 TAK patients with immunodeficiency in our literature search. Two of the patients with c-TAK were infected with human immunodeficiency virus (HIV), another patient had Wiskott-Aldrich syndrome, and the other had idiopathic CD4 + T lymphocytopenia. Nine adult patients with TAK were infected with HIV, three patients had common variable immunodeficiency disorder (CVID), and the other had STAT1 gain-of-function mutation. Clinicians should consider that immunodeficiencies may be accompanied by vasculitic conditions such as TAK. Hypertension, increased inflammatory markers, and constitutional symptoms may be red flags for the development of TAK.
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Round KJ, Rosen JL, Yost CC, Guy TS. Submitral aneurysm: Exploring a rare pathology. J Card Surg 2022; 37:2682-2684. [PMID: 35661259 DOI: 10.1111/jocs.16664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Kellen J Round
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jake L Rosen
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Colin C Yost
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - T Sloane Guy
- Department of Surgery, Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Cardiac Outpouchings: Definitions, Differential Diagnosis, and Therapeutic Approach. Cardiol Res Pract 2021; 2021:6792643. [PMID: 34567801 PMCID: PMC8463251 DOI: 10.1155/2021/6792643] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
Background and Aims Cardiac outpouchings encounter a series of distinct congenital or acquired entities (i.e. aneurysms, pseudoaneurysms, diverticula, and herniations), whose knowledge is still poorly widespread in clinical practice. This review aims to provide a comprehensive overview focusing on definition, differential diagnosis, and prognostic outcomes of cardiac outpouchings, as well as further insights on therapeutic options, in order to assist physicians in the most appropriate decision-making. Methods The material reviewed was obtained by the following search engines: MEDLINE (PubMed), EMBASE, Google Scholar, and Clinical Trials databases, from January 1966 until March 2021. We searched for the following keywords (in title and/or abstract): (“cardiac” OR “heart”) AND (“outpouching” OR “outpouch” OR “aneurysm” OR “pseudoaneurysm” OR “false aneurysm” OR “diverticulum” OR “herniation”). Review articles, original articles, case series, and case reports with literature review were included in our search. Data from patients with congenital or acquired cardiac outpouchings, from prenatal to geriatric age range, were investigated. Results Out of the 378 papers initially retrieved, 165 duplicates and 84 records in languages other than English were removed. Among the 129 remaining articles, 76 were included in our research material, on the basis of the following inclusion criteria: (a) papers pertaining to the research topic; (b) peer-reviewed articles; (c) using standardized diagnostic criteria; and (d) reporting raw prevalence data. Location, morphologic features, wall motion abnormalities, and tissue characterization were found to have a significant impact in recognition and differential diagnosis of cardiac outpouchings as well as to play a significant role in defining their natural history and prognostic outcomes. Conclusions Careful recognition of cardiac outpouchings remains a diagnostic challenge in clinical practice. Due to a broad cluster of distinctive and heterogeneous entities, their knowledge and timely recognition play a pivotal role in order to provide the most appropriate clinical management and therapeutic approach.
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Raghuram P, Sivakumar K, Sheriff EA. Acquired submitral aneurysms may be associated with mitral paravalvular leaks. Asian Cardiovasc Thorac Ann 2021; 29:822-825. [PMID: 33789441 DOI: 10.1177/02184923211006310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acquired submitral aneurysm after mitral valve replacement is caused by weakness of the annular tissues induced by inflammation, scarring, and ischemia from surgical trauma. The asynchronous stretch of the annulus caused by the submitral aneurysm may cause recurrent paravalvular leaks. In patients with acquired submitral aneurysms and paravalvular leaks, ideal solution is a repeat surgery to address both the aneurysm and the leak. However, when patients are at high risk for repeat surgeries on cardiopulmonary bypass through sternotomy, transcatheter closure of these paravalvar leaks may offer an alternative solution. Four such procedures in three patients are detailed in this report.
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Affiliation(s)
- Palaparti Raghuram
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India
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Abstract
Cardiac outpouchings pose a diagnostic challenge when encountered in practice, as the signs, symptoms, and initial investigations, such as radiographs and electrocardiogram, are nonspecific. They may remain asymptomatic and be incidentally detected. However, a few may present with progressive shortness of breath, thromboembolic complications, arrhythmias, pressure effects, rupture, or even death. Imaging is of paramount importance in establishing an accurate diagnosis, delineating morphology and extent of the lesion along with its hemodynamic significance, planning management, and in the follow-up.
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Vargas-Hitos JA, Jiménez-Jáimez J, Molina Navarro E, Salmerón Ruiz A, López Milena G, Jiménez-Alonso J. Takayasu arteritis, malignant hypertension and severe left ventricular hypertrophy. Int J Rheum Dis 2019; 22:951-955. [PMID: 30861323 DOI: 10.1111/1756-185x.13541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 11/30/2022]
Affiliation(s)
- José Antonio Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves¨ University Hospital, Granada, Spain
| | - Juan Jiménez-Jáimez
- Cardiology Department, ¨Virgen de las Nieves¨ University Hospital, Granada, Spain
| | | | - Angela Salmerón Ruiz
- Radiology Department, ¨Virgen de las Nieves¨ University Hospital, Granada, Spain
| | - Genaro López Milena
- Radiology Department, ¨Virgen de las Nieves¨ University Hospital, Granada, Spain
| | - Juan Jiménez-Alonso
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves¨ University Hospital, Granada, Spain
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Abdullah H, Jiyen K, Othman N. Multimodality cardiac imaging of submitral left ventricular aneurysm with concurrent descending aorta mycotic aneurysm. BMJ Case Rep 2017; 2017:bcr-2017-221466. [PMID: 28954754 DOI: 10.1136/bcr-2017-221466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of a 20-year-old Malay man with underlying tuberculous (TB) lymphadenitis who presented with shortness of breath and found to have submitral left ventricular aneurysm (SLVA). SLVA is well recognised but rare. Incidence of SLVA in Malay has never been documented. This is the first reported case of SLVA in Malays with concomitant thoracic aorta mycotic aneurysm. TB has been reported to be associated with SLVA. Treatment is either surgical or conservative. Imaging is required for diagnosis and preoperative assessment. Multimodality imaging include echocardiography (ECHO), cardiac CTangiography and the robust multiparametric cardiac MR (CMR). ECHO is the first line imaging and useful for initial detection of the aneurysm. CMR including the late gadolinium enhancement allows excellent visualisation of the LV aneurysm, tissue characterisation, cardiac function and detection of associated pathology as shown in this case.
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Affiliation(s)
- Hazrini Abdullah
- Department of Imaging, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - Kam Jiyen
- Department of Cardiology, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - Norliza Othman
- Department of Imaging, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
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Abstract
Human immunodeficiency virus (HIV) infection continues to be a leading cause of morbidity and mortality. HIV-infected individuals are now surviving for a relatively longer period and this is because of easy accessibility to antiretroviral therapy these days. As a result, chronic disease-related complications are now being recognized more often. Kidney disease in HIV-infected children can vary from glomerular to tubular-interstitial involvement. We searched the database to identify various kidney diseases seen in HIV-infected children. We describe the epidemiology, pathogenesis, pathology, clinical and laboratory manifestations, management and outcome of commonly seen kidney disease in HIV-infected children. We also provide a brief overview of toxicity of antiretroviral drugs seen in HIV-infected children. Kidney involvement in HIV-infected children may arise because of HIV infection per se, opportunistic infections, immune mediated injury and drug toxicity. HIV-associated nephropathy is perhaps the most common and most severe form of kidney disease. Proteinuria may be a cost-effective screening test in the long-term management of HIV-infected children, however, there are no definite recommendations for the same. Other important renal diseases are HIV immune complex kidney disease, thrombotic microangiopathy, interstitial nephritis and vasculitis.
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Affiliation(s)
- Ankur Kumar Jindal
- a Department of Paediatrics, Allergy Immunology and Nephrology Unit , Advanced Paediatrics Centre, Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Karalanglin Tiewsoh
- a Department of Paediatrics, Allergy Immunology and Nephrology Unit , Advanced Paediatrics Centre, Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Rakesh Kumar Pilania
- a Department of Paediatrics, Allergy Immunology and Nephrology Unit , Advanced Paediatrics Centre, Postgraduate Institute of Medical Education and Research , Chandigarh , India
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Herrera CN, Tomala-Haz JE. Portal hypertension: an uncommon clinical manifestation of Takayasu arteritis in a 9-year-old child. Open Access Rheumatol 2016; 8:115-118. [PMID: 27895519 PMCID: PMC5117910 DOI: 10.2147/oarrr.s114689] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Takayasu arteritis (TA) is the third most common childhood vasculitis and its clinical manifestations depend on the arteries involved. We report a case of a 9-year-old boy with multiple aneurysms in carotid and iliac arteries, subclavian and coronary arteries, and abdominal aorta. At the age of 7 years, he presented with recurrent fever and hepatosplenomegaly. An angio-computed tomography scan showed aneurysms in the left subclavian artery, abdominal aorta, and both proximal iliac arteries. He was diagnosed with TA and was treated with corticosteroids, aspirin, and enalapril. One year later, he was admitted to Dr Roberto Gilbert Children's Hospital because of intracranial hemorrhage. Angiography revealed enlargement of aneurysms enlargement and new aneurysms. He also developed portal hypertension. Treatment with intravenous corticosteroids, azathioprine, and monthly intravenous cyclophosphamide was begun. After 6 months of no improvement, infliximab was begun. The aim of this article was to report the concurrence of coronary involvement and portal vein hypertension in pediatric TA because there were scarce reports on this matter.
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Affiliation(s)
- Cristina N Herrera
- Department of Pediatric Rheumatology, Dr Roberto Gilbert Children’s Hospital, Guayaquil, Ecuador
| | - Javier E Tomala-Haz
- Department of Pediatric Rheumatology, Dr Roberto Gilbert Children’s Hospital, Guayaquil, Ecuador
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Shukla V, Nath RK, Pandit N. Ruptured submitral aneurysm. Indian Heart J 2016; 68 Suppl 2:S175-S177. [PMID: 27751280 PMCID: PMC5067383 DOI: 10.1016/j.ihj.2015.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 07/07/2015] [Indexed: 11/22/2022] Open
Abstract
Submitral aneurysm is a rare entity, with around few hundred cases reported till date. Presentation can be varied. We describe here a case of submitral aneurysm in a young male with rupture into the left atrium cavity.
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Affiliation(s)
- V Shukla
- Senior Resident, Department of Cardiology, P.G.I.M.E.R., Dr. R.M.L. Hospital, India.
| | - R K Nath
- Professor, Department of Cardiology, P.G.I.M.E.R., Dr. R.M.L. Hospital, India
| | - N Pandit
- Professor and Head, Department of Cardiology, P.G.I.M.E.R., Dr. R.M.L. Hospital, India
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Manuel V, Sousa-Uva M, Miguel G, Magalhães MP, Pedro A, Júnior APF, Morais H. Submitral aneurysm in children. J Card Surg 2016; 31:551-5. [PMID: 27375232 DOI: 10.1111/jocs.12789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We report a surgical series of submitral aneurysm in children. METHODS Between March 2011 and December 2015, eight consecutive patients less than 18 years old with submitral aneurysm underwent surgical correction. RESULTS Six patients were female, the mean age was 7 ± 3.8 years old, and mean weight was 21.4 kg. Six patients were in NYHA functional class III or IV. Six patients underwent repair via a transatrial approach, another with a transatrial combined with transaneurysmal approach, and another with a transventricular approach. There were no in-hospital deaths but one 30-day mortality. One patient required reoperation. Two patients required mitral valve replacement. At discharge, one patient had severe and another had moderate mitral regurgitation. The mean follow-up time was 26.4 months and five patients were alive. No reintervention was required. CONCLUSIONS Submitral aneurysm is not restricted to adults. Heart failure is the commonest clinical presentation in the pediatric age. The transatrial approach is feasible, safe, and associated with good short-term results. The mitral valve can be preserved in the majority of cases.
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Affiliation(s)
- Valdano Manuel
- Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola
| | - Miguel Sousa-Uva
- Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola
- Hospital Cruz Vermelha, Lisbon, Portugal
| | - Gade Miguel
- Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola
| | - Manuel Pedro Magalhães
- Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola
- Hospital Cruz Vermelha, Lisbon, Portugal
| | - Albino Pedro
- Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola
| | | | - Humberto Morais
- Department of Cardiology, Hospital Militar Principal/Instituto Superior, Luanda, Angola
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