Syphilitic aortitis

Syphilitic aortitis is a form of aortitis which occurs due to syphilis. It usually occurs in tertiary syphilis often 10-30 years after initial infection.

Complications

• progression into a luetic aneurysm
• aortic valvular insufficiency
• coronary ostial involvement with coronary ostial stenosis
• dilation of the aortic root

History and etymology

The first case series describing valvular leaflet incompetence as a mechanism underlying aortic regurgitation featured patients predominantly affected by syphilitic aortitis. The English physicians Charles Aston Key (1793–1849) and Thomas Hodgkin (1798-1866) collaborated in the description of the precordial auscultatory findings in aortic regurgitation; the characteristic early diastolic decrescendo loudest along the left sternal border is accordingly (albeit seldomly) referred to as the Key-Hodgkin murmur ⁸.

The latter speculated that the structural pathology which many of the patients shared resulted in an inability of the aortic valve to appropriately close and prevent the reflux of blood back into the left ventricle. He also noted many of the patients had valves which were abnormally "retroverted," and further speculated that the aortic root dilation present in most likely contributed to the valvular incompetence ⁹.