Syphilitic aortic regurgitation. An appraisal of surgical treatment

Abstract

During the 10 years from 1964 to 1973, 15 patients with severe syphilitic aortic regurgitation were treated surgically at the National Heart Hospital. In 13 the valve was replaced and in 2 it was repaired. In addition 4 had replacement of an aneurysmal ascending aorta with a Dacron graft and seven some form of plastic repair to the coronary ostia. Three patients died within 1 month of surgery and a further 6 during the follow up period which varied from 1 to 55 months (mean 25.5). The 6 survivors have been followed up for an average of 33 months. Factors contributing to this high mortality were analysed and it was found that the mean duration of effort dyspnoea was 22 months in the survivors compared with 48 mth in those who had died. Similarly the average duration of nocturnal dyspnoea was 4 months in the survivors compared with a mean of 8 months in those who had died. Only six out of the fifteen patients had angina; this was present in two of the survivors and in four of the fatalities. The pulse pressure, heart size, and hemodynamic findings were similar in the two groups. The prognostic value of an elevated erythrocyte sedimentation rate was also examined. It was concluded that preoperative investigations should include aortography, coronary arteriography, an assessment of left ventricular function, and whenever possible myocardial biopsy. These data were interpreted as suggesting that patients should be referred for surgery at an earlier stage in the disease, certainly before the onset of cardiac failure, and that if this more aggressive attitude was adopted, as it has been in non syphilitic cases of aortic valve disease, the present high mortality in this group would be reduced.