Shigenori Morooka

Clinical features and course of aortitis syndrome in japanese women older than 40 years

The clinical features and course of aortitis syndrome were studied in 11 women older than 40 years of age. The patients were Japanese women, mean age 57 +/- 6 years old, who were followed for 6.9 +/- 3.8 years. Data from 24 young patients were used for comparison. In the older patients, systemic hypertension (73%), calcification of the aorta (73%), left ventricular hypertrophy (92%) and cardiomegaly (82%) were frequent, whereas the erythrocyte sedimentation rate was normal in 5 patients and only slightly accelerated in 6. C-reactive protein was positive in 2. The incidence of cardiac involvement and inflammatory signs was significantly different from findings in the young patients. Aortic regurgitation (AR) (55%) was significantly more frequent and renal artery stenosis was not observed. Other arterial lesions revealed a pattern similar to those seen in the young patients. An irregular luminal surface, kinking and calcification were present in the lesions in the older patients. The survival rate at 5 years was 80%. Five of 6 patients with AR had congestive heart failure, 4 of whom died. One died after a stroke. Thus, aortitis syndrome in older patients has a long course. There is usually an associated AR, renal artery stenosis is rare and other arterial lesions do not change a great deal. The prognosis may be good, but depends on the association of AR.

The Size of Kidney with Renovascular Hypertension in Patients with Aortitis Syndrome

Renal atrophy due to the renal artery stenosis associated with aortitis syn drome was studied in seven patients. Severe hypertension, high plasma renin activity and normal overall renal functions were present in all. The luminal diameter of the stenosed renal artery seen on the angiogram was less than 1.5 mm at the maximum area of stenosis in all patients. The size of the kidney with renal artery stenosis was diminished, ranging from 8.0 to 14.0 cm in longitudi nal diameter on the nephrogram. Histological findings of the small kidney re vealed ischemic atrophy. Although the rate of progression of the arterial stenosis was uncertain, the collateral circulation was found to be rich. Renal atrophy was not frequent and not marked even in the presence of high grade renal stenosis or obstruction in case of renovascular hypertension secondary to the arteritis.