Keywords: Aortic insuffi ciency, aortoarteritis, COVID-19, echocardiography, computed tomography


Aortoarteritis is a rare cause of the aortic insuffi ciency, but it should be considered among the other causes of aortic regurgitation. A number of cases of autoimmune aortoarteritis have been reported during the COVID-19 pandemic.

We present a case report of aortoarteritis with severe aortic insuffi ciency, which developed in a patient after a mild form of coronavirus infection and an episode of arthritis. Echocardiography revealed severe aortic regurgitation, dilatation of the thoracic aorta and thickening of the aortic walls. Ultrasonography showed thickening of the carotid arterial walls. Computed tomography confi rmed the diagnosis of aortoarteritis. Elevated C-reactive protein indicated an acute infl ammatory process. Aortoarteritis was treated with methylprednisolone with good clinical response.

Possible causes of aortoarteritis are discussed: Takayasu arteritis, giant cell arteritis, ankylosing spondylitis and polychondritis. After exclusion of all possible causes, aortoarteritis in the patient was diagnosed as an autoimmune process caused by coronavirus infection. Cases of arteritis in patients related to COVID-19 are discussed. Multimodality diagnostics (echocardiography, contrast-enhanced computed tomography, ultrasonography of aortic branches) play a central role in detecting aortic lesions and evaluating the extent of the pathological process in aortitis. A laboratory workup is needed to identify the cause of the aortitis. The fi nal diagnosis should be made on the analysis of clinical manifestations, diagnostic and laboratory fi ndings.


Download data is not yet available.


Litmanovich D.E., Yıldırım A., Bankier, A.A. Insights into imaging of aortitis. Insights Imaging. 2012; 3: 545-560. doi: 10.1007/s13244-012-0192-x

Zhu FP, Luo S, Wang ZJ. et al. Takayasu arteritis: imaging spectrum at multidetector CT angiography. Br J Radiol. 2012;85(1020):e1282-e1292. doi:10.1259/bjr/25536451

Yuan SM, Lin H. Annuloaortic Ectasia and Arteritis: Clinical Features, Treatments of Choice, and Caus- ative Relations. Braz J Cardiovasc Surg. 2019;34(4):472-479. doi: 10.21470/1678-9741-2018-0252

Loricera J, Blanco R, Hernández JL, et al. Non-infectious aortitis: a report of 32 cases from a single ter- tiary centre in a 4-year period and literature review. Clin Exp Rheumatol. 2015;33(2 Suppl 89):S-19-31.

Adachi O, Saiki Y, Akasaka J, et al. Surgical management of aortic regurgitation associated with Takaya- su arteritis and other forms of aortitis. Ann Thorac Surg. 2007;84(6):1950-1953. doi: 10.1016/j.atho- racsur.2007.07.025

Dejaco C, Ramiro S, Duftner C, et al. EULAR recommendations for the use of imaging in large ves- sel vasculitis in clinical practice. Ann Rheum Dis. 2018; 77(5):636-43. doi: 10.1136/annrheum- dis-2017-212649

Ying S, Sifan W, Yujiao W, et al. Clinical characteristics, imaging phenotypes and events free survival in Takayasu arteritis patients with hypertension. Arthritis Res Ther. 2021;23(1):196. doi: 10.1186/ s13075-021-02579-8..

Podgorska D, Podgorski R, Aebisher D, Dabrowski P. Takayasu arteritis - epidemiology, pathogenesis, diagnosis and treatment. J Appl Biomed. 2019 Mar;17(1):20. DOI: 10.32725/jab.2018.005

Villiger PM. Großgefäßvaskulitiden : Riesenzellarteriitis und Takayasu-Arteriitis [Large vessel vasculitis : Giant cell arteritis and Takayasu arteritis]. Z Rheumatol. 2017;76(6):509-523. doi: 10.1007/s00393-017-0331-3.

Inoue T, Matsumoto T, Saga T. Massive progression of annuloaortic ectasia in a patient with Takayasu aortitis. Can J Cardiol. 2007;23(12):993- 994. DOI: 10.1016/s0828-282x(07)70863-2

Boparai N, Girgis M, Kiamanesh O, et al. Takayasu Arteritis Causing Aortitis and Aortic Regurgitation: A Totally Tubular Case Report. CASE (Phila). 2020;5(1):62-66. doi:10.1016/

Hanna RM, Yang WT, Jene Kim S, et al. Three Presentations of Takayasu's Arteritis in Hispanic Pa- tients. Case Rep Med. 2012;2012:839795. doi:10.1155/2012/839795

Arend WP, Michel BA, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classi-

fication of Takayasu arteritis. Arthritis Rheum 1990;33(8): 1129-1134. DOI: 10.1002/art.1780330811

Espitia O, Blonz G, Urbanski G,et al.; French Study Group for Large Vessel Vasculitis (GEFA). Symp- tomatic aortitis at giant cell arteritis diagnosis: a prognostic factor of aortic event. Arthritis Res Ther. 2021;23(1):14. DOI: 10.1186/s13075-020-02396-5

Espitia O, Samson M, Le Gallou T, et al. Comparison of idiopathic (isolated) aortitis and giant cell arteritis-related aortitis. A French retrospective multicenter study of 117 patients. Autoimmun Rev. 2016;15:571-576. DOI: 10.1016/j.autrev.2016.02.016

Gelsomino S, Romagnoli S, Gori F, et al. Annuloaortic ectasia and giant cell arteritis. Ann Thorac Surg. 2005;80(1):101-105. DOI: 10.1016/j.athoracsur.2005.01.063

Padma SK, Gopalakrishnan M, Sajitha K, Impana BD. Giant cell arteritis causing annuloaortic ectasia. Heart India. 2014;2(3):86-87. DOI: 10.4103/2321-449x.140234

Yoshikawa E, Ohno N, Hamuro M, et al. [Incidental diagnosis of giant cell arteritis during a hybrid sur- gical approach in a patient with annuloaortic ectasia and an extensive thoracic aortic aneurysm]. Kyobu Geka. 2014;67(12):1079-1083

Moss AJ, Pessotto R, Flapan AD. A 59-year-old woman with visible precordial pulsations. Heart. 2018;104(3):273-274. doi: 10.1136/heartjnl-2017-312193

Roldan C. A., Chavez J., Wiest P. W., Qualls C. R., Crawford M. H. Aortic root disease and valve disease associated with ankylosing spondylitis. Journal of the American College of Cardiology. 1998;32(5):1397-1404. doi: 10.1016/s0735-1097(98)00393-3

Klingberg E, Sveälv B, Täng M, et al. Aortic regurgitation is common in ankylosing spondylitis: time for routine echocardiography evaluation? Am J Med. 2015;128:1244- 1250. doi: 10.1016/ jmed.2015.04.032.

Balčiūnaitė A, Budrikis A, Rumbinaitė E, et al. Ankylosing Spondyloarthritis Resulting Severe Aortic Insufficiency and Aortitis: Exacerbation of Ankylosing Spondyloarthritis and Stenosis of the Main Left Coronary Artery after Mechanical Aortic Valve Implantation with Cardiopulmonary Bypass. Case Rep Rheumatol. 2020 Jan 3;2020:9538527. doi:10.1155/2020/9538527

Chetrit M, Khan MA, Kapadia S. State of the Art Management of Aortic Valve Disease in Ankylosing Spondylitis. Curr Rheumatol Rep. 2020. 14;22(6):23. doi:10.1007/s11926-020-00898-4

Selim AA, Fulford LG, Mohiaddin RH, et al Active aortitis in relapsing polychondritis Journal of Clinical Pathology 2001;54:890-892. DOI: 10.1136/jcp.54.11.890

25. Bae D, Lum C, Chand R, et al. Relapsing Polychondritis Requiring Orthotopic Heart Transplant Despite Cor- onary Artery Bypass and Surgical Aortic Valve Replacement. JACC Case Rep. 2020 Aug 19;2(10):1527- 1531. DOI: 10.1016/j.jaccas.2020.05.100

Silvestri V, Recchia GE. Aortic Pathology During COVID - 19 Pandemics. Clinical Reports in Literature and Open Questions on the two Co-Occurring Conditions. Ann Vasc Surg. 2021;75:109-119. doi: 10.1016/j. avsg.2021.02.037.

Akgul A , Turkyilmaz S , Turkyilmaz G , Toz H . Acute aortic dissection surgery in patient with COVID-19. Ann Thorac Surg 2021;111(1):e1-e3 . doi:10.1016/j.athoracsur.2020.06.005

Dhakal P, Sushmita Khadka S, et al., Aortitis in COVID-19, IDCases, 2021. 24, e01063. doi:10.1016/j. idcr.2021.e01063

Shergill S, Davies J, Bloomfield J Florid aortitis following SARS-CoV-2 infection, European Heart Journal, 2020. 41(44), 4286. doi:10.1093/eurheartj/ehaa635

Salman R, Masand P, Huisman TAGMet al. A Novel Large-Vessel Arteritis in SARS-CoV-2-Related Multi- system Inflammatory Syndrome in Children (MIS-C). Radiol Cardiothorac Imaging. 2021;3(1):e200535. doi:10.1148/ryct.2020200535

Pillay B, Ramdial PK, Naidoo DP. HIV-associated large-vessel vasculopathy: a review of the current and emerging clinicopathological spectrum in vascular surgical practice. Cardiovasc J Afr 2015;26(2):70-81. doi:10.5830/CVJA-2015-017

Szabo S. COVID-19: new disease and chaos with panic, associated with stress. Proc Shevchenko Sci Soc Med Sci [Internet]. 2020;59(1):41-62. doi:10.25040/ntsh2020.01.14

Manenti A , Farinetti A , Manco G , et al. Vasculitis and aortitis: COVID-19 challenging complications. J Vasc Surg 2021;73:347-348 . doi:10.1016/j.jvs.2020.08.029

Rodríguez-Pla A, Stone JH. Vasculitis and systemic infections. Curr Opin Rheumatol. 2006 Jan;18(1):39- 47. doi:10.1097/01.bor.0000197999.58073.2e

Chopyak V; Lishchuk-Yakymovych K; Pukalyak R. Immunological aspects of covid-2019: realities and prospects Immunology and Allergy: Science and Practice, 2020, 3-4: 34-41. immunology.2020.3-4-04

Abstract views: 72
PDF Downloads: 68
How to Cite
Oryshchyn N, Ivaniv Y. AORTOARTERITIS AND SEVERE AORTIC INSUFFI CIENCY IN A PATIENT AFTER COVID-19. Proc Shevchenko Sci Soc Med Sci [Internet]. 2022Jun.27 [cited 2022Oct.7];66(1). Available from: