A Case of an Ascending Aortic Aneurysm due to Mesoaortitis Complicated with Idiopathic Thrombocytopenic Purpura

Kenji Matsuzaki, MD, Norihiko Shiiya, MD, Suguru Kubota, MD, Takashi Kunihara, MD, Toshifumi Murashita, MD, Yoshiro Matsui, MD, and Keishu Yasuda, MD

An 80-year-old man was referred to our hospital for the surgical treatment of an ascending aortic aneurysm. The diagnosis of idiopathic thombocytonenic purpura was also made by hematological studies which included the examination of the aspirated bone marrow. Preoperative chest computed tomography showed an ascending aortic aneurysm with a maximum diameter of 80 mm. Echocardiography demonstrated mild aortic regurgitation. The platelet count increased by intravenous administration of immunoglobulin. A prosthetic graft replacement of the ascending aorta and aortic valve repair were carried out with the aid of cardiopulmonary bypass, selective cerebral perfusion and hypothermic circulatory arrest. No difficulty was encountered in hemostasis and the postoperative course was uneventful. Histological examination of the aneurysmal wall showed chronic mesoaortitis with patchy destruction of musculo-elastic medial tissue and adventitial focal lymphocytic infiltrates that were similar to syphilitic mesoaortitis, although serological treponemal tests were all negative. Perioperative administration of gamma-globulin is useful to minimize the hemorrhagic complication in a patient undergoing cardiovascular surgery with idiopathic thrombocytopenic purpura. (Ann Thorac Cardiovasc Surg 2001; 7: 315-318)

Key words: idiopathic thrombocytopenic purpura (ITP), mesoaortitis, ascending aortic aneurysm, aortic valve repair

From the Department of Cardiovascular Surgery, Hokkaido University School of Medicine, Sapporo, Japan

Received January 9, 2001; accepted for publication February 6, 2001
Address reprint requests to Kenji Matsuzaki, MD: Department of Cardiovascular Surgery, Hokkaido University School of Medicine, Kita-14, Nishi-5, Kita-ku, Sapporo 060-8648, Japan.