The heart team at Blackpool Victoria Hospital in England had already decided this operation would be difficult. Their patient, a 72-year-old woman, had severe low-flow aortic stenosis, a left ventricular ejection fraction of 15%, and a systemic vasculitis that made her blood vessels a question mark. What they did not anticipate was the color.
Once the ascending aorta was open, the tunica intima, its innermost lining, was distinctly blue, the discoloration extending toward the aortic valve. The outer layer looked normal. The surgeons proceeded, implanted the valve, and later wrote that they could find no prior report of this finding in a patient with Churg-Strauss syndrome. The case report appeared this month in the Journal of Surgical Case Reports, from clinicians at Blackpool Teaching Hospitals, Yeovil District Hospital, the University of Khartoum and St. George's University.
