Syphilitic coronary ostial stenosis. Case reports.

Two young Coloured men with proven syphilitic coronary ostial stenosis had severe angina pectoris unresponsive to conventional medication. One underwent an aortic valve replacement for severe aortic insufficiency associated with subtotal ostial occlusion of the right coronary artery (RCA), which was corrected by an aortocoronary bypass graft; the left coronary artery (LCA) ostium was normal and patent. The other patient had total occlusion of the LCA ostium which resulted in an extensive transmural anteroseptal and anterolateral myocardial infarction; the RCA ostium was unaffected and the aortic valve appeared normal. He was considered unsuitable for cardiac surgery and continued to receive anti-anginal drug therapy with quite satisfactory improvement in symptoms. Non-atheromatous coronary artery disease must always be sought for and excluded when a non-White patient presents with symptoms of ischaemic heart disease. Although atheromatous coronary artery involvement is becoming increasingly prevalent among 'westernized' Black and Coloured subjects, it is still relatively unusual in comparison with the extremely high incidence in the White population.