Author + information
- Received July 31, 2012
- Revision received September 12, 2012
- Accepted September 25, 2012
- Published online March 26, 2013.
A 9-year-old girl presented with cervical mass 2 months before heart failure. Her grandfather had died of tuberculosis 6 years previously. Tuberculous lymphadenitis was proved by biopsy of a neck mass, and chest radiography revealed no pulmonary tuberculosis or cardiomegaly (A). She developed heart failure and cardiomegaly (B) 1 month after the initiation of an antituberculosis regimen.
Echocardiography revealed a dilated left atrium and left ventricle with decreased left ventricular ejection fraction (35%). Computed tomography showed severe discrete stenosis in the thoracic aorta, with the narrowest diameter measured as 3 mm (C, D). The diagnosis of Takayasu arteritis was established because the patient had evident angiographic abnormalities, high blood pressure at the bilateral upper extremities (150/96 mm Hg), an undetectable pulse at the bilateral lower extremities, and bruit over the aorta (1–3). Methylprednisolone was administered for 4 weeks, but heart failure and aortic stenosis did not diminish.
On angiography, severe aortic stenosis with contrast medium stasis proximal to the stenotic site could be seen (E, Online Video 1). Transcatheter stent implantation was performed using a Cordis Genesis stent (10 × 27 mm/12 × 25 mm; Cordis Corporation, Miami Lakes, Florida), and the pressure gradient dropped from 95 to 13 mm Hg (F,G, Online Video 2). Fifty days after stent implantation, the patient's left ventricular ejection fraction had returned to normal. Chest radiography also demonstrated normalization of heart size.
- Received July 31, 2012.
- Revision received September 12, 2012.
- Accepted September 25, 2012.
- American College of Cardiology Foundation
- Pantell R.H.,
- Goodman B.W. Jr.