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Tang C, Song Y, Huang X, Li Y, Tuerxun Y, Hu X, Li H, Wu L. Surgical treatment of Behcet's disease with severe aortic regurgitation. Front Cardiovasc Med 2023; 10:1290615. [PMID: 38054086 PMCID: PMC10694211 DOI: 10.3389/fcvm.2023.1290615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/30/2023] [Indexed: 12/07/2023] Open
Abstract
Behcet's disease (BD) is a multisystem inflammatory disease that is characterized by oral aphthosis, genital aphthosis, ocular lesions, and cutaneous lesions. Although BD rarely affects the cardiovascular system, its symptoms can be shown as aortic regurgitation (AR), which requires surgical intervention. Due to the special pathogenesis of BD, a low preoperative diagnosis rate and a high incidence of serious complications, such as perivalvular leakage, valve detachment, and pseudoaneurysm after prosthetic valve replacement, surgical treatment of BD with severe AR has a poor prognosis. In recent years, new surgical strategies have been developed to improve treatment efficacy for this disease. This article reviews and summarizes the evolution of surgical techniques for BD with AR and aims to provide a reference for optimizing surgical strategies, improving perioperative management, and assisting prognosis in patients suffering from BD with severe AR.
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Affiliation(s)
- Chuanbin Tang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Song
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaofan Huang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanming Li
- Second Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | | | - Xingjian Hu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huadong Li
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Long Wu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Qian X, Guo H, Sun J, Zhao D. Flanged Bentall procedure for paravalvular leakage and pseudoaneurysm after root replacement in Behcet's disease and infective endocarditis: a case report. Eur Heart J Case Rep 2023; 7:ytad489. [PMID: 37954567 PMCID: PMC10633786 DOI: 10.1093/ehjcr/ytad489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/19/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023]
Abstract
Background Behcet's disease is a multi-systemic inflammatory disorder. Paravalvular leakage and aortic pseudoaneurysm are rare in patients with Behcet's disease after aortic root replacement. Complicated post-operative infective endocarditis can make the treatment more difficult. We applied a flanged Bentall procedure to treat one such case. Case summary A 27-year-old man with aortic regurgitation and Behcet's disease underwent aortic root replacement. Post-operative electrocardiogram showed a complete atrioventricular block. One year after the operation, he underwent percutaneous temporary pacemaker implantation and endovascular stent graft exclusion because of pseudoaneurysm of the ascending aorta. Post-operative fever and blood culture confirmed infective endocarditis. Examination showed paravalvular leakage and pseudoaneurysm recurrence. Then, the patient underwent a third operation in our hospital. Aortic root replacement with a flanged composite valved conduit was performed. Immunosuppressants and antibiotic treatment were given after surgery. After 3 months, the cardiovascular examination was normal, and the patient was in good condition. Discussion Surgical treatment of aortic regurgitation caused by Behcet's disease was characterized by a high rate of paravalvular leakage, which led to reoperation and high mortality. Combined infective endocarditis would further increase the difficulty and risk of treatment. It is important to maintain effective immunosuppressive therapy while monitoring serum biomarkers and inflammation indicators. The potential hazards of immunosuppressants are increased risk of infection and poor tissue healing. In our case, targeted antibiotic treatment and appropriate immunosuppressive therapy were well balanced. The flanged Bentall procedure was also the key to success, which could increase aortic effective orifice area and reduce the risk of dehiscence.
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Affiliation(s)
- Xiangyang Qian
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, People’s Republic of China
| | - Hongwei Guo
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, People’s Republic of China
| | - Jing Sun
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, People’s Republic of China
| | - Dong Zhao
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, People’s Republic of China
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Choi HM, Kim HK, Park SJ, Lee HJ, Yoon YE, Park JB, Kim YJ, Cho GY, Hwang IC, Sohn DW, Oh JK. Predictors of paravalvular aortic regurgitation after surgery for Behcet's disease-related severe aortic regurgitation. Orphanet J Rare Dis 2019; 14:132. [PMID: 31182113 PMCID: PMC6558675 DOI: 10.1186/s13023-019-1083-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 04/26/2019] [Indexed: 01/12/2023] Open
Abstract
Background Behcet’s disease (BD)-related aortic regurgitation (AR) is known to be associated with paravalvular leakage (PVL) after successful aortic valve (AV) surgery. This study aimed to determine predictors of PVL after successful AV surgery in BD patients. We retrospectively collected data of 35 patients (42.1 ± 9.1 years, 27 men) who underwent surgery for severe BD-related AR at two tertiary centers. The diagnosis was established based on echocardiographic, surgical, and/or pathological findings in conjunction with the International Study Group criteria for BD. A total of 76 cases of AV surgery in 35 patients were analyzed. Results A median follow-up duration was 8.0 years (interquartile range, 5.4–14.3 years). PVL developed in 18 patients (51.4%) within 2 years after the first surgery. Six patients who met the diagnostic criteria for BD did not develop PVL, in whom 5 patients took immunosuppressive therapy (IST). However, 4 of 9 patients (44.4%) who did not meet the diagnostic criteria developed PVL, in whom four (44.4%) patients took IST. On multivariable analysis, postoperative IST and concomitant aortic root replacement (ARR) were two independent predictors for less PVL development (HR 0.38, 95% CI 0.17–0.89, p = 0.025 for postoperative IST; HR 0.17, 95% CI 0.08–0.36, p < 0.001 for concomitant ARR). Preoperative IST use did not determine PVL development (p = 0.75). Conclusions Postoperative, but not preoperative, IST and concomitant ARR were independent predictors of less development of PVL. Special attention is required for early diagnosis BD-related AR, especially in patients not satisfying the current diagnostic criteria. Electronic supplementary material The online version of this article (10.1186/s13023-019-1083-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hong-Mi Choi
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do, South Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Hyun-Jung Lee
- Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Yeonyee E Yoon
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do, South Korea
| | - Jun-Bean Park
- Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Yong-Jin Kim
- Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Goo-Young Cho
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do, South Korea
| | - In-Chang Hwang
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do, South Korea
| | - Dae-Won Sohn
- Division of Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae K Oh
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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