Reply to Comment on Aortic Aneurysm: Dissection from the Root to Pelvis

Dear Editor, We thank Dr. Mahmood Al-Mendalawi who has thoroughly read and raised his comments on our article titled “Aortic Aneurysm: Dissection from the Root to Pelvis,”[1] recently published in the January–March 2025 issue of the Journal of Medical Ultrasound. Dr. Al-Mendalawi raised the concern of syphilis and its late consequences of vasculitis and vascular complications involving the cardiovascular system. We would like to provide additional demographic information. The patient described in our case had a national health registry medical record indicating no sexually transmitted diseases. We also listed the risk factors in the Discussion section (paragraph 2; page 65). Numerous studies[2-4] have revealed that the following factors contribute to aortic aneurysm dissection, listed in accordance with their prevalence and relevance: history of hypertension, prior aortic dissection, prior cardiac surgery, atherosclerosis, diabetes, smoking, chronic obstructive pulmonary disease, Marfan syndrome, and family history of aortic dissection. Aortic aneurysm, particularly in the thoracic aorta, is the main cardiovascular manifestation and is observed in 28%–54% of all patients with syphilis. Despite the presence of large aortic aneurysms, syphilitic aneurysms rarely dissect.[5] Patients with syphilis in Taiwan have access to free medical treatment and serological testing, which minimizes the likelihood of progression to tertiary syphilis. In conclusion, the effect of Marfan syndrome on aortic dissection in this case outweighed the contribution of syphilis. Financial support and sponsorship Research support grant from Chang Gung Memorial Hospital CMRPVVL0231 and CMRPVVN0091. Conflicts of interest There are no conflicts of interest.