"Severe Aortic Regurgitation as the Initial Manifestation of Takayasu Arteritis in a Young Woman: A Case Report".

Takayasu arteritis (TAK) is a rare large-vessel vasculitis primarily affecting young women, characterized by idiopathic inflammation of the aorta and its major branches. While aortic regurgitation (AR) is a recognized complication, it typically occurs in advanced disease stages. Isolated severe AR as the initial manifestation is exceptionally uncommon and poses diagnostic challenges. We present a 39-year-old woman with no prior medical history who presented with progressive exertional dyspnea (NYHA Class II) and exertional chest pain. Physical examination revealed absent upper limb pulses, unmeasurable brachial blood pressure, and a diastolic murmur. Transthoracic echocardiography demonstrated severe AR with left ventricular dysfunction (EF 48%). CT and MR angiography confirmed circumferential aortic wall thickening, subclavian artery occlusions, and ostial right coronary artery stenosis. Elevated inflammatory markers (ESR and CRP) and vascular imaging findings established the diagnosis of TAK based on the 1996 Modified Ishikawa Criteria. Initial treatment included high-dose glucocorticoids and methotrexate for disease control. Due to persistent severe AR, the patient underwent successful mechanical aortic valve replacement. Postoperative recovery was uncomplicated, with significant clinical improvement at 1-year follow-up and no disease recurrence. This case illustrates that severe AR can rarely serve as the initial manifestation of TAK, emphasizing the importance of considering large-vessel vasculitis in young patients with unexplained valvulopathy and systemic inflammation. Early diagnosis, combined medical-surgical management, and careful long-term monitoring are essential for optimizing outcomes in this high-risk population.