Cardiovascular involvement of ankylosing spondylitis: report of three cases.

Cardiovascular involvement is one of the extra-articular manifestations of ankylosing spondylitis. Of these, aortic disease and aortic regurgitation are the most commonly associated cardiovascular disorders. Since 2005, three male patients with ankylosing spondylitis were referred to The Chaim Sheba Medical Center for surgical treatment of cardiovascular associations. The diagnosis of ankylosing spondylitis was evidenced by radiography and/or laboratory tests of C-reactive protein or HLA-B27. Apart from the usual cardiac manifestations including heart block and left ventricular hypertrophy, usual associated disorders such as aortic aneurysmal dilation, bicuspid aortic valve, aortic root dilation and myocardial infarction, and solely bicuspid aortic valve that developed in these patients warranted a surgical intervention. Aortic aneurysmal dilation is a recognized rare association with ankylosing spondylitis, and bicuspid aortic valve or coronary artery disease is only occasionally present. Decreased aortic elasticity with impaired endothelial function could be responsible for the development of the aortic complication in ankylosing spondylitis patients. The underlying mechanisms of these associations are discussed.