Hostname: page-component-848d4c4894-4hhp2 Total loading time: 0 Render date: 2024-06-09T21:16:48.562Z Has data issue: false hasContentIssue false
  • English
  • Français

Review of children with Takayasu’s arteritis at a Southern African tertiary care centre

Published online by Cambridge University Press:  06 July 2018

Antoinette M. Cilliers ,
Paul E. Adams ,
Hopewell Ntsinjana  and
Udai Kala
Antoinette M. Cilliers*
Affiliation:
Division of Paediatric Cardiology, C.H. Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
Paul E. Adams
Affiliation:
Division of Paediatric Cardiology, C.H. Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
Hopewell Ntsinjana
Affiliation:
Division of Paediatric Cardiology, C.H. Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
Udai Kala
Affiliation:
Division of Nephrology, C.H. Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
*
Author for correspondence: Dr A. M. Cilliers, Paediatric Cardiology, C.H. Baragwanath Academic Hospital, P.O. Bertsham, 2013 Johannesburg, South Africa. Tel: +27 11833435803; Fax: +27 119389074; E-mail: antoinette.cilliers@wits.ac.za
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Takayasu’s arteritis is a rare idiopathic arteritis causing stenosis or aneurysms of the aorta, pulmonary arteries, and their branches. It usually occurs in women, but has been described in children.

Objective

The objective of this study was to determine the clinical presentation, demographic profile, vascular involvement, origins, management, and outcome of children diagnosed with Takayasu’s arteritis at a Southern African tertiary care centre between 1993 and 2015.

Methods

This is a retrospective analysis of all children with Takayasu’s arteritis captured on a computerised electronic database during the study period.

Results

A total of 55 children were identified. The female:male ratio was 3.2:1, and the mean age was 9.7±3.04 years. Most originated outside the provincial borders of the study centre. The majority presented with hypertension and heart failure. In all, 37 (67%) patients had a cardiomyopathy with a mean fractional shortening of 15±5%. A positive purified protein derivative test was documented in 73%. Abdominal aorta and renal artery stenosis were the predominant angiographic lesions. A total of 23 patients underwent 30 percutaneous interventions of the aorta, pulmonary, and renal arteries: eight stents, 22 balloon angioplasties, and seven had nephrectomies. All patients received empiric tuberculosis treatment, immunosuppressive therapy, and anti-hypertensive agents as required. Overall, there was a significant reduction in systolic blood pressure and improvement in fractional shortening (p<0.05) with all treatments.

Conclusion

Takayasu’s arteritis is more common in girls and frequently manifests with hypertension and heart failure. The abdominal aorta and renal arteries are mostly affected. Immunosuppressive, anti-hypertensive, and vascular intervention therapies improve blood pressure control and cardiac function.

Keywords

Takayasuarteritisstenosisstentshypertension
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 9 , September 2018 , pp. 1129 - 1135
Check for updates
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Cite this article: Cilliers AM, Adams PE, Ntsinjana H, Kala U. (2018) Review of children with Takayasu’s arteritis at a southern African tertiary care centre. Cardiology in the Young28: 1129–1135. doi: 10.1017/S1047951118000938

References

1. Serra, R, Butrico, L, Fugetto, F, et al. Updates in pathophysiology, diagnosis and management of Takayasu Arteritis. Ann Vasc Surg 2016; 35: 210–225.CrossRefGoogle ScholarPubMed
2. Kerr, GS, Hallahan, CW, Giordano, J, et al. Takayasu arteritis. Ann Intern Med 1994; 120: 919–929.Google Scholar
3. Kinare, SG. Aortitis in early life in India and its association with tuberculosis. J Pathol 1970; 100: 69–76.Google Scholar
4. Lupi, HE, Sanchez Torres, G, Castillo, PU. Cutaneous reactivity to PPD and antigens of atypical mycobacteria (kansash avium and fortuitum) in patients with unspecific artertits. (in Spanish). Arch Inst Cardiol Mex 1972; 42: 717–725.Google Scholar
5. Ladapo, TA, Gajjar, P, McCulloch, M, Scott, C, Numanoglu, A, Nourse, P. Impact of revascularization on hypertension in children with Takayasu’s arteritis-induced renal artery stenosis: a 21-year review. Pediatr Nephrol 2015; 30: 1289–1295.Google Scholar
6. Kothari, SS. Aetiopathogenesis of Takayasu’s arteritis and BCG vaccination: the missing link? Med Hypotheses 1995; 45: 227–230.Google Scholar
7. Scott, DG, Salmon, M, Scott, DL, et al. Takayasu’s arteritis: a pathogenic role for cytotoxic T-lymphocytes? Clin Rheumatol 1986; 5: 517–522.Google Scholar
8. Hirsh, MS, Aikat, BK, Basu, AK. Takayasu’s arteritis: report of 5 cases with immunologic studies. Johns Hopkins Med J 1964; 115: 29–64.Google Scholar
9. Takeda, N, Takahashi, T, Seko, Y, et al. Takayasu myocarditis mediated by cytotoxic T lymphocytes. Intern Med 2005; 44: 256–260.Google Scholar
10. Seko, Y, Minota, S, Kawasaki, A, et al. Perforin-secreting killer cell infiltration and expression of a 65-kD heat-shock protein in aortic tissue of patients with Takayasu’s arteritis. J Clin Invest 1994; 93: 750–758.CrossRefGoogle ScholarPubMed
11. Kimura, A, Ota, M, Katsuyama, Y, et al. Mapping of the HLA-linked genes controlling the susceptibility to Takayasu’s arteritis. Int J Cardiol 2000; 75: S105–S110.CrossRefGoogle ScholarPubMed
12. Yajima, M, Numano, F, Park, YB, Sagar, S. Comparative studies of patients with Takayasu arteritis in Japan, Korea and India – comparison of clinical manifestations, angiography, and HLA-B antigen. Jpn Circ J 1994; 58: 9–14.CrossRefGoogle ScholarPubMed
13. Lande, A, Bard, R, Rossi, P, Passariello, R, Castrucci, A. Takayasus’s arteritis. A world-wide entity. N Y State J Med 1976; 76: 1447–1482.Google Scholar
14. Hall, S, Barr, W, Lie, JT, Stanson, AW, Kazmier, FJ, Hunder, GG. Takayasu arteritis. A study of 32 North American patients. Medicine(Baltimore) 1985; 64: 89–99.Google Scholar
15. Waern, AU, Andersson, P, Hemmingsson, A. Takayasu’s arteritis: a hospital region based study on occurrence, treatment and prognosis. Angiology 1983; 34: 311–320.CrossRefGoogle Scholar
16. Ladhani, S, Tulloh, R, Anderson, D. Takayasu disease masquerading as interruption of the aortic arch in a 2 year old child. Cardiol Young 2001; 11: 244–246.Google Scholar
17. Sekiguchi, M, Sazuki, J. An overview of Takayasu arteritis. Heart Vessels 1992; 7 (Suppl 1): 6–10.Google Scholar
18. Shrivastava, S, Srivastava, RN, Tandon, R. Ideopathic obstructive aortoarteritis in children. Indian Paediatr 1986; 23: 403–410.Google Scholar
19. Brunner, J, Feldman, BM, Tyrrell, PN, et al. Takayasu arteritis in children and adolescents. Rheumatology 2010; 49: 1806–1814.CrossRefGoogle ScholarPubMed
20. Hahn, D, Thomson, PD, Kala, U, Beale, PG, Levin, SE. A review of Takayasu’s arteritis in children in Gauteng, South Africa. Pediatr Nephrol 1998; 12: 668–675.Google Scholar
21. Wiggelinkhuizen, J, Cremin, BJ. Takayasu artertitis and renovascular hypertension in childhood. Pediatrics 1978; 62: 209–217.CrossRefGoogle Scholar
22. Lupi-Herrera, E, Sanchez-Torres, G, Marcushamer, J, Misipreta, J, Horwitz, S, Vela, JE. Takayasu’s arteritis. Clinical study of 107 cases. Am Heart J 1977; 93: 94–103.Google Scholar
23. Talwar, KK, Kumar, K, Chopra, P, et al. Cardiac involvement in nonspecific aortoarteritis (Takayasu’s arteritis). Am Heart J 1991; 122: 1666–1670.Google Scholar
24. Panja, M, Kar, AK, Dutta, AL, Chhetri, M, Kumar, S, Panja, S. Cardiac involvement in non-specific aorto-arteritis. Int J Cardiol 1992; 34: 289–295.Google Scholar
25. Liang, P, Tan-Ong, M, Hoffman, GS. Takayasu’s arteritis: vascular interventions and outcomes. J Rheumatol 2004; 31: 102–106.Google Scholar
26. Weaver, FA, Yellin, AE, Campen, DH, et al. Surgical procedures in the management of Takayasu’s artertitis. J Vasc Surg 1990; 12: 429–439.CrossRefGoogle Scholar
27. Arend, WP, Michel, BA, Bloch, DA, et al. The American College of Rheumatology 1990 Criteria for the classification of Takayasu arteritis. Arthritis Rheum 1990; 33: 1129–1134.Google Scholar
28. Ozen, S, Ruperto, N, Dillon, MJ, et al. EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides. Ann Rheum Dis 2005; 65: 936–941.Google Scholar
29. Gutgesell, HP, Paquet, M, Duff, DF, McNamara, DG. Evaluation of left ventricular size and function by echocardiography. Results in normal children. Circulation 1977; 56: 457–462.Google Scholar
30. Pantonowitz, D. (ed). Modern Surgery in Africa: The Baragwanath Experience. Southern Book Publishers, Johannesburg, 1988.Google Scholar
31. Nasu, T. Pathology of pulseless disease. A systematic study and critical review of twenty-one autopsy cases reported in Japan. Angiology 1963; 14: 225–242.CrossRefGoogle ScholarPubMed
32. Isaacson, C, Klachko, DM, Wayburne, S, Simson, IW. Aortitis in children. Lancet 1959; 2: 543–544.Google Scholar
33. Isaacson, C, Schnier, M. Aortitis: a review with a further case report of an idiopathic type in an African child. Med Proc 1961; 7: 523–533.Google Scholar
34. Schrire, V, Asherson, RA. Arteritis of the aorta and its major branches. Q J Med 1964; 33: 439–463.Google Scholar
35. Cooper, K, Chetty, R. Takayasu’s aorto-arteritis. A report of 11 cases at King Edward VIII Hospital, Durban. S Afr Med J 1987; 72: 711–713.Google Scholar
36. McCulloch, M, Andronikou, S, Goddard, E, et al. Angiographic features of 26 children with Takayasu’s arteritis. Pediatr Radiol 2003; 33: 230–235.CrossRefGoogle ScholarPubMed
37. Mwipatayi, BP, Jeffery, PC, Beningfield, SJ, et al. Takayasu arteritis: clinical features and management: a report of 272 cases. ANZ J Surg 2005; 75: 110–117.Google Scholar
38. Saadoun, D, Lambert, M, Mirault, T, et al. Retrospective analysis of surgery versus endovascular intervention in Takayasu arteritis: a multicentre experience. Circulation 2012; 125: 813–819.Google Scholar
39. Nakabayashi, K, Kurata, N, Nangi, N, Miyane, H, Nagasawa, T. Pulmonary artery involvement as first manifestation in three cases of Takayasu arteritis. Int J Cardiol 1996; 54 (Suppl): S177–S183.Google Scholar