Complete recovery of severe left ventricular systolic dysfunction and mitral regurgitation after stenting of the descending thoracic and infra-renal aorta in a patient with Takayasu arteritis
Abstract
A 16-year-old girl was referred for
evaluation of worsening breathlessness,
limb claudication (both legs and left arm)
and weight loss of three years duration.
Physical examination revealed discrepancy
in arterial pulses, palpable pulsations
in the supra-sternal region and intercostal
spaces carotid, intercostal and
abdominal aortic bruit S3 gallop and pansystolic
murmur of mitral regurgitation.
Inflammatory markers were markedly
elevated. Echocardiography showed severe
left ventricular (LV) systolic dysfunction
(LV ejection fraction 25 ) with moderately
severe mitral regurgitation. On angiography,
long segment tubular stenosis
of descending thoracic aorta and infrarenal
aorta was seen with significant narrowing
of multiple branches of the aorta.
Central aortic pressure was 20078 (124)
mm-Hg with peak gradients of 48 mm-Hg
across the descending thoracic aorta and
40 mm-Hg across the infra-renal abdominal
aorta. A diagnosis of type-V Takayasu
arteritis was made using the angiographic
classification.
Percutaneous angioplasty and deployment
of self-expanding Wallstents was performed
across both stenotic segments after
initial medical stabilization. Since then she
has been free of lower limb claudication,
and at 6 months follow-up her LV systolic
function had normalized (LV ejection fraction
52) with regression of mitral regurgitation.
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