PMC10130679_01
Trans-radial coronary angiogram. Slit-like left main ostium. The rest of the coronaries were free from atherosclerosis.
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Urgent cardiac catheterization showed an unusual picture of a slit-like left main coronary artery ostium, with the rest of the coronaries free from atherosclerotic plaque (Figure 1).
Multiplanar computed tomographic reconstruction of the aortic root. Thickened and calcified circumferential plaque at the level of the sinotubular junction, causing subtotal obstruction of the left coronary ostium and partial obstruction of the right. (A) Circumferential aortic wall intimal thickening involving the sinotubular junction; (B) extension of the intimal thickening to the superior aspect of right coronary ostium; (C) origin of the left main ostium was severely encroached by the thickened aortic intima; (D) atretic left coronary ostium.
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To facilitate operative planning, an electrocardiogram (ECG)-gated CT of the aortic root was performed, which demonstrated thickened and calcified circumferential plaque at the level of the sinotubular junction, causing subtotal obstruction of the left coronary ostium and partial obstruction of the right (Figure 2).
Transthoracic and trans-esophageal echocardiogram. Trileaflet aortic valve free from vegetations. Delayed closure of the left coronary cusp noted.
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Histopathological examination confirmed the diagnosis of syphilitic aortitis (Figures 3,4).
High-power histophotomicrograph of the aortic valve specimen. (A) Intense plasma cell infiltration of the aortic valve (HE, x200); (B) positive immunohistochemical staining with a polyclonal antibody to spirochetes (Biocare Medical, California, 1:300 dilution, x300).
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An overview of the patient's course was presented in a timeline in Figure 5.