Acquired Left Ventricular Submitral Aneurysms in the Course of Takayasu Arteritis in a Child Alban-Elouen Baruteau, MD,* †‡§¶ Raphaël Pedro Martins, MD,* †‡§ Dominique Boulmier, MD,* †‡§ Adeline Basquin, MD,* †‡§ David Briard, MD, # Virginie Gandemer, MD, # and Jean-Marc Schleich, MD, PhD* †‡§ *CHU Rennes, Cardiology Department, Rennes, France; † Rennes 1 University, LTSI, Rennes, France; ‡ INSERM, CIC-IT 804, Rennes, France; § INSERM, U642, Rennes, France; ¶ INSERM, U915, Nantes, France; # CHU Rennes, Pediatric Department, Rennes 1 University, Rennes, France ABSTRACT A 9-year-old black African boy was hospitalized for heart failure revealing a severe left ventricular dysfunction associated with dilated cardiomyopathy, two submitral aneurysms, occlusion of the circumflex artery and a giant coronary artery aneurysm on the proximal left anterior descending artery. The boy was coinfected with human immunodeficiency virus and Mycobacterium tuberculosis. Though rare, association of Takayasu arteritis and submitral aneurysm leads to rethinking the pathogenesis of submitral aneurysm and suggests that some of them may be acquired. In our case, a common inflammatory process, possibly triggered by tuberculosis or HIV, may underlie Takayasu and submitral aneurysms. Key Words. Pediatrics; Inflammation; AIDS; Aneurysm; Coronary Disease O ne month after arriving in France, an 11-year-old black Congolese boy presented fever and breathlessness. His medical history included an episode of malaria necessitating a blood transfusion 7 years prior. Clinical examina- tion revealed a 3/6 apex systolic murmur, blood pressure asymmetry in the upper limbs without arterial hypertension (95/50 mm Hg in the right arm and 55/30 mm Hg in the left arm), the absence of the left radial pulse and physical signs of left heart failure with tachycardia, tachypnea and crackles in the two-lung fields. All other pulses were found without asymmetry. A 12-lead electrocardiogram showed normal sinus rhythm with complete right bundle branch block, left atrial hypertrophy, and an abnormal Q wave in lateral leads. Echocardiography revealed a depressed left ventricular ejection fraction at 25% with postero- and latero-basal akinesia. Aneurysmal deformations of the ventricular wall, situated beneath the posterior leaflet of the mitral valve, were associated with massive mitral regurgitation (Figure 1, Panels A and B). Vascular Doppler revealed vasculitis lesions of the verte- bral, subclavian, and femoral arteries (Figure 1, Panels C and D). The celiac trunk was occluded. A 64-slice cardiac computed tomography scan diagnosed two large postero- and latero-basal submitral aneurysms communicating with the dilated left ventricular cavity (Figure 2, Panel A). The circumflex artery, in contact with an aneu- rysm, was occluded. A giant coronary aneurysm was situated on the proximal left anterior descending artery (Figure 2, Panels B, C, and D). The boy was coinfected with human im- munodeficiency virus (HIV) and Mycobacterium tuberculosis. Investigations ruled out viral, bacterial, and parasitic HIV-associated vasculitis. Takayasu arteritis was diagnosed with 90.5% sensitivity and 97.8% specificity, as more than three of the six American College of Rheumatology criteria were met. 1 The boy was placed on a regimen of vitamin K antagonist, beta-adrenergic blocker, angiotensin-converting enzyme inhibitor, anti-aldosterone agent, corticosteroid therapy, antitubercular therapy, and highly active antiret- roviral therapy, and was doing well 3 years later. The incidence of HIV-associated vasculitis, including Takayasu’s disease, is less than 1%. Takayasu’s arteritis, which carries a 40% mortality rate in the absence of treatment, is the third most common vasculitis in children. This rare chronic 76 © 2011 Wiley Periodicals, Inc. Congenit Heart Dis. 2012;7:76–79