title: Lone aortic insufficiency and conduction disease: a marker of reactive arthritis.
abstract: A 48-year-old male with history of chronic arthritis and uveitis presented with 1 year of progressively reduced exercise capacity and nonexertional chest pain. Physical examination was consistent with severe aortic insufficiency. An electrocardiogram demonstrated sinus rhythm with first degree atrioventricular block. Transthoracic and transesophageal echocardiography demonstrated severe lone central aortic insufficiency of a trileaflet valve due to leaflet thickening, retraction of leaflet margins and mild aortic root dilation in the setting of left ventricular dilatation. In addition, computed tomographic angiography revealed a small focal aneurysm of the distal transverse arch. He was found to be positive for the immunogenetic marker HLA-B27. The patient subsequently underwent uncomplicated mechanical aortic valve replacement. The diagnosis of HLA-B27 associated cardiac disease should be entertained in any individual with lone aortic insufficiency, especially if accompanied by conduction disease.
authors: Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York.
authors: Joshua M
authors: JM
authors: Lader
authors: Geoffrey
authors: G
authors: Lam
authors: Robert
authors: R
authors: Donnino
authors: Edward S
authors: ES
authors: Katz
authors: Abe
authors: A
authors: DeAnda
authors: Mark
authors: M
authors: Ettel
authors: Muhamed
authors: M
authors: Saric
mesh_terms: D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery; D016918:Arthritis, Reactive / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D054537:Atrioventricular Block / Q000150:complications* / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D017548:Echocardiography, Transesophageal / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D015796:HLA-B27 Antigen / Q000097:blood; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D015415:Biomarkers; D015796:HLA-B27 Antigen
keywords: HLA-B27; Reiter's syndrome; aortic insufficiency; reactive arthritis