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

• Published in: Cardiology in the young Vol. 28; no. 9; pp. 1129 - 1135
• Main Authors: Cilliers, Antoinette M., Adams, Paul E., Ntsinjana, Hopewell, Kala, Udai
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.09.2018
• Subjects: Age; Antihypertensives; Aorta; Arteries; Arteritis; Balloon treatment; Blood pressure; Cardiology; Cardiomyopathy; Children; Classification; Coronary vessels; Demographics; Girls; Heart; Heart diseases; Heart failure; Hypertension; Immunosuppressive agents; Implants; Lesions; Original Article; Patients; Proteins; Pulmonary arteries; Pulmonary artery; Renal artery; Rheumatology; Stenosis; Tuberculin; Tuberculosis; Vein & artery diseases; Veins & arteries; South Africa; Takayasu; arteritis; stenosis; hypertension; stents
• ISSN: 1047-9511; 1467-1107
• DOI: 10.1017/S1047951118000938

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