Tertiary lues complicated with aortita luetica and coronarita luetica

Abstract

Introduction: Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum subspecies pallidum spirocheta. Tertiary syphilis is the only one of the three forms of syphilis, which can cause cardiovascular complications (aortita luetica, coronarita luetica-angina). It occurs in approxim ately 3-15 years after the initial infection and may be presented in three different forms: gom atos (15% ), syphilis, neurosyphilis tardy (6.5%) and cardiovascular syphilis (10%). The detection of the disease is made, usually by a serological test (SYPHILIS TPHA-VDRL), but the bacteria can be seen under a microscope. Without treatment, one third of infected people arrive at the tertiary stage. At this stage the disease is not infectious. Materials and methods: We present a patient of 39 years with acute myocardial infarction in august 2004, complicated in evolution with early postinfarct angina, is admitted in September 2004 in the Centre of Cardiology Iasi, at coronarography were found the following faults: 95% stenosis of left main, occlusion ACD and aortic insufficiency major. During preoperative evaluation, the patient is diagnosed with Lues tertiary complicated with aortita and coronarita luetica, that's why surgery was temporizated for treatment. Currently admitted to surgery. Imaging tests (echocardiography, CT thoracic, Rx-scan) and invasive (cardiac catheterization, coronarography) have revealed the cardiovascular injuries inflicted by the tertiary lues. Surgical procedure consisted in a by-pass aorto-coronary artery with reversed VSI on the ACD, resuspend the commissure of CNC and CCD and cognitive enlargement on the left main and ascending aorta with PVA (autologous venous patch). At the same time of surgical treatment the patient recieved Penicillin G 3 mil. IU x 2/day for 14 days for Lues tertiary. Results. During the postoperative evolution was favorable, with the healing of surgical wounds completely and disappear the symptomatology with chest pain. Clinical assessment I month postoperatively showed a very good evolution, the patient was asymptomatic. On the 26.08.20013 patient returns to a routine check after a period of 9 years, this being asymptomatic. Conclusions. In the case of tertiary lues complicated with aortita and coronarita luetica and associated with angina, the conduit therapeutic is different because surgery should be temporizated for specific treatment for lues. After it was done the therapy with antibiotics, you can then intervene surgically in order to solve complications of myocardial and lues.