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Wu P, Yu S, Zeng J, Yang L. Aortic sinus aneurysm invading ventricular septum and dissection caused by Behcet's disease: a case report and literature review. BMC Cardiovasc Disord 2023; 23:429. [PMID: 37648972 PMCID: PMC10468877 DOI: 10.1186/s12872-023-03420-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 07/27/2023] [Indexed: 09/01/2023] Open
Abstract
Few case reports have mentioned the aortic sinus aneurysm invading ventricular septum and dissection caused by Behcet's disease. Here, we reported a 36-year-old male patient with an aortic sinus aneurysm invading the ventricular septum and dissection caused by Behcet's disease, who manifested as recurrent chest tightness and shortness of breath. Cardiac ultrasound showed the rupture of the right aortic sinus and the formation of ventricular septal dissection. Ascending aortic valve prosthesis replacement, mitral valvuloplasty with ring implantation and tricuspid valvuloplasty were performed. Postoperatively, he was treated with hormones, hydroxychloroquine sulfate, mycophenolate mofetil tablets, thalidomide and warfarin, and his symptoms were relieved. This is a rare case easily being misdiagnosed and missed, early diagnosis and in-time treatment are crucial to avoid surgical complications. The diagnostic and therapeutic approaches of this patient were reported and related literature was reviewed in this case report.
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Affiliation(s)
- Pengjia Wu
- Department of Rheumatology and Immunology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, China
| | - Shaomei Yu
- Department of Rheumatology and Immunology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, China
| | - Jiashun Zeng
- Department of Rheumatology and Immunology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, China.
| | - Lei Yang
- Department of Rheumatology and Immunology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, China
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Hu HO, Zhang CH, Spadaccio C, Tang B, Li CN, Qiao ZY, Zheng T, Zhu JM, Sun LZ. Surgical management of aortic regurgitation secondary to Behcet's disease. Front Cardiovasc Med 2023; 10:1093024. [PMID: 37008328 PMCID: PMC10064057 DOI: 10.3389/fcvm.2023.1093024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/02/2023] [Indexed: 03/19/2023] Open
Abstract
BackgroundAortic regurgitation (AR) related to Behcet's disease (BD) is rare, but usually fatal. Perivalvular leakage (PVL) is high if AR related to BD treated with regular AVR. In this study, we report the surgical management of AR secondary to BD.MethodsBetween September 2017 and April 2022, 38 patients with AR secondary to Behcet's disease had surgery in our center. 17 patients did not have a BD diagnosis before surgery, 2 of them were diagnosed during surgery and received Bentall procedure. The remaining 15 patients received conventional AVR. 21 patients were diagnosed as BD before surgery, all of them received modified Bentall procedures. All patients were followed up by regular outpatient visits, transthoracic echocardiogram and CT angiography were performed to evaluate the aorta and aortic valve.ResultsSeventeen patients did not have a BD diagnosis at the time of surgery. Out of them, 15 patients received conventional AVR, and a total of 13 patients suffered PVL after surgery. Twenty-one patients had a BD diagnosis before surgery. They received modified Bentall procedures and IST and steroids were given both pre- and post-surgery. In this group treated with Bentall procedure no patient suffered PVL during follow up.ConclusionsPVL is a complex scenario after conventional AVR for AR in BD. Modified Bentall procedure seems superior to isolated AVR in these cases. The use of IST and steroids before and after surgery in combination with modified Bentall procedure could have a role in effectively reducing PVL.
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Affiliation(s)
- Hai-Ou Hu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Chen-Han Zhang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Cristiano Spadaccio
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States
| | - Bing Tang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Cheng-Nan Li
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Zhi-Yu Qiao
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Tie Zheng
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Jun-Ming Zhu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
- Correspondence: Zhu Jun-Ming
| | - Li-Zhong Sun
- Department of Cardiovascular Surgery, DeltaHealth Hospital·Shanghai, Shanghai, China
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Thoracic Complications in Behçet's Disease: Imaging Findings. Can Respir J 2020; 2020:4649081. [PMID: 32566055 PMCID: PMC7275231 DOI: 10.1155/2020/4649081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022] Open
Abstract
Behçet's disease (BD) causes vascular inflammation and necrosis in a wide range of organs and tissues. In the thorax, it may cause vascular complications, affecting the aorta, brachiocephalic arteries, bronchial arteries, pulmonary arteries, pulmonary veins, capillaries, and mediastinal and thoracic inlet veins. In BD, chest radiograph is commonly used for the initial assessment of pulmonary symptoms and complications and for follow-up and establishment of the response to treatment. With the advancement of helical or multislice computed tomography (CT) technologies, such noninvasive imaging techniques have been employed for the diagnosis of vascular lesions, vascular complications, and pulmonary parenchymal manifestations of BD. CT scan (especially, CT angiography) has been used to determine the presence and severity of pulmonary complications without resorting to more invasive procedures, in conjunction with gadolinium-enhanced three-dimensional (3D) gradient-echo magnetic resonance (MR) imaging with the subtraction of arterial phase images. These radiologic methods have characteristics that are complementary to each other in diagnosis of the thoracic complications in BD. 3D ultrashort echo time (UTE) MR imaging (MRI) could potentially yield superior image quality for pulmonary vessels and lung parenchyma when compared with breath-hold 3D MR angiography.
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Khairy HM, Shaker AA. Outcomes of segmental femoral artery pseudoaneurysm in patients with Behçet's disease: a single center's experience. J Vasc Bras 2019; 18:e20180132. [PMID: 31762774 PMCID: PMC6852701 DOI: 10.1590/1677-5449.180139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Behçet's disease (BD) is an autoimmune condition that involves multiple systems. The most common arterial manifestation in BD patients is pseudoaneurysm, which has higher frequency than aneurysm formation. Objectives To clarify the importance of profunda femoris artery in BD pseudoaneurysm, and present a new method for identifying healthy segments for anastomosis. Methods Fifteen patients presented at a vascular department with pseudoaneurysms of the common femoral (CFA) and superficial femoral artery (SFA), were diagnosed with BD and underwent surgical intervention at Kasr al Ainy hospitals over 2 years. Results All patients were male. The patients ranged in age from 30 to 40 years (mean, 33.8±2.6 years). Mean duration of the disease was 5±3.4 years. Eight (53.3%) CFA graft interpositions, six (40%) mid SFA graft interpositions, and one (6.66) distal SFA graft interposition were performed. Eight (53.3%) of these operations were performed using Dacron graft and sartorius flap, three (20%) were performed with a polytetrafluoroethylene graft, and four (26.66) with a great saphenous vein graft. Two cases (13.33%) were accidentally discovered while four cases (26.66%) had short distance claudication, four cases (26.66%) had pain at rest, and five cases (33.33%) presented with pulsatile swelling correlated with pseudoaneurysm size (p = 0.005). Patients were followed-up over 1 year for new aneurysms and recurrence. Conclusions Surgical repair with muscle flap coverage, with or without ligation of profunda femoris artery, does not affect prognosis. An alternative method for identifying healthy segments of femoral artery may be frozen section and examination of the artery to decrease the risk of recurrence at the site of anastomosis.
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Affiliation(s)
- Hussein Mahmoud Khairy
- Cairo University, Kasr Al Ainy Hospitals, Vascular and Endovascular Department, Cairo, Egypt
| | - Ahmed Alaa Shaker
- Cairo University, Kasr Al Ainy Hospitals, Vascular and Endovascular Department, Cairo, Egypt
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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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Ozel D, Ozel BD, Ozkan F, Kutlu R. Evalution of Renal Involvement in Patients with Behçet Disease: Need to be Aware About Potential Hypertension in Long Term Follow Up? Pol J Radiol 2016; 81:5-9. [PMID: 26937259 PMCID: PMC4750757 DOI: 10.12659/pjr.895446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 08/11/2015] [Indexed: 01/21/2023] Open
Abstract
BACKROUND The aim of this study was to evaluate frequency and severity of kidney involvement with some clinical, ultrasonography and color Doppler measurements in patients with Behçet disease. MATERIAL/METHODS This study was including 32 patients with Behçet disease and 32 healthy sex and age-matched control subjects. Patients were divided into two groups as period of disease 0-6 years and 7 years and above to evaluate effect of duration of disease. We evaluated some biochemical tests in both blood and urine related to renal functions, blood pressure values. Gray scale and color Doppler findings were noted. RESULTS Renal artery volume flow in patients with a duration of 7 years or above was significantly decreased compared to control group (p<0.05). However, gray scale ultrasound and color Doppler measurements reveal there was not statistically significant change compared to control group. There was no biochemical abnormalities in any patient. Four patients had elevated blood pressure but mean blood pressure values were not statistically different compared to volunteers. CONCLUSIONS Renal involvement ratios varies in different studies but not common. End stage renal failure can be seen very rare. Furthermore, vasculitic changes can lead renal artery narrowness and can result to decrease in renal blood flow. It has a potential to activate renin angiotensin aldosterone cascade to elevate blood pressure. We must be aware about blood pressure of patients with Behçet disease, especially with long term follow up.
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Affiliation(s)
- Deniz Ozel
- Radiology Clinic, Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - Betul Duran Ozel
- Radiology Clinic, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Fuat Ozkan
- Radiology Clinic, Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - Ramazan Kutlu
- Department of Radiology, İnönü University, Faculty of Medicine, Malatya, Turkey
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Park SJ, Lee JW, Kim JB. Emergency Quadrido-Bentall Procedure for Aortic Rupture in a Patient with Behcet's Disease. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:364-7. [PMID: 26509132 PMCID: PMC4622037 DOI: 10.5090/kjtcs.2015.48.5.364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/23/2014] [Accepted: 01/06/2015] [Indexed: 11/16/2022]
Abstract
Cardiovascular involvement in cases of Behcet's disease is a rare but life-threatening condition, and prosthetic valve detachment is a frequent and serious complication attributable to Behcet's disease following the surgical repair of aortic regurgitation. We report the case of a patient with Behcet's disease presenting with contained aortic rupture around the aortic root. The patient had previously undergone aortic valve surgery three times due to recurrent prosthetic valve detachment. An emergency operation was performed, consisting of aortic root replacement (ARR) using a composite valved conduit and the replacement of the hemiarch. ARR may be an appropriate surgical option for patients with Behcet's disease in order to prevent recurrence of the disease.
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Affiliation(s)
- Sung Jun Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jeong-Woo Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
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Şahin DY, Elbasan Z, Gür M, Huseinov M, Çaylı M. Successful treatment for a giant coronary saccular aneurysm complicated with myocardial infarction in a patient with Behcet's disease: Case report. J Cardiol Cases 2012; 6:e118-e120. [PMID: 31391871 PMCID: PMC6436560 DOI: 10.1016/j.jccase.2012.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 06/12/2012] [Accepted: 07/12/2012] [Indexed: 12/13/2022] Open
Abstract
We report on a 35-year-old man, with known Behcet's disease, who was admitted with the diagnosis of subacute anterior myocardial infarction. Coronary angiography revealed an isolated giant saccular aneurysm at the mid segment of left anterior descending coronary artery with a tight stenosis. The patient was successfully treated with covered stent on the first day of admission.
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Affiliation(s)
- Durmuş Yıldıray Şahin
- Department of Cardiology, Adana Numune Education and Research Hospital, Adana 01150, Turkey
| | - Zafer Elbasan
- Department of Cardiology, Adana Numune Education and Research Hospital, Adana 01150, Turkey
| | - Mustafa Gür
- Department of Cardiology, Adana Numune Education and Research Hospital, Adana 01150, Turkey
| | - Mehman Huseinov
- Department of Cardiology, Acıbadem Adana Hospital, Acıbadem University, Adana, Turkey
| | - Murat Çaylı
- Department of Cardiology, Adana Numune Education and Research Hospital, Adana 01150, Turkey
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Jan RA, Khan UH, Wani KA, Wani R, Javead G, Shah S, Mufti S, Mudasir S, Sofi FA, Koul PA. Behçet's disease presenting as ileal perforation and a thrombosed renal artery aneurysm. INDIAN JOURNAL OF RHEUMATOLOGY 2012. [DOI: 10.1016/s0973-3698(12)60018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Ma WG, Zheng J, Zhu JM, Liu YM, Li M, Sun LZ. Aortic Regurgitation Caused by Behçet's Disease: Surgical Experience during an 11-Year Period. J Card Surg 2012; 27:39-44. [DOI: 10.1111/j.1540-8191.2011.01392.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Liang MY, Yao JP, Zhang X, Wang ZP. Surgical technique for aortic regurgitation attributable to Behcet's disease: modified aortic valve replacement with reinforcement
of the aortic wall. Eur J Cardiothorac Surg 2011; 41:647-8. [DOI: 10.1093/ejcts/ezr025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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The estimated pulmonary artery pressure can be elevated in Behçet’s syndrome. Respir Med 2011; 105:1739-47. [DOI: 10.1016/j.rmed.2011.07.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Revised: 07/26/2011] [Accepted: 07/27/2011] [Indexed: 11/22/2022]
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[Behcet syndrome: thirty comments with lung and vascular injury of peripheral vessels]. Presse Med 2011; 41:e52-62. [PMID: 21868192 DOI: 10.1016/j.lpm.2011.05.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 05/05/2011] [Accepted: 05/20/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Behcet's disease is a systematic vasculitis of unknown cause, characterized essentially by eye, cutaneous, articular, neurological and vascular manifestations. METHODS We retrospectively analysed the Behcet's disease cases that were followed up in our ward from January 2000 to January 2009. The inclusion criteria were those of International Study Group on Behçet's disease (aphthosis mouth was required). Data were retrieved and analysed with two softwares (Access(®) and Epi Info(®)). RESULTS We observed 30 cases with vascular lesions on a series of 92 patients with Behcet's disease. Most patients were male, with an average age around 40. The venous manifestations, concerning essentially the lower limbs (deep and superficial thrombosis) were found at 27 patients (90 %), and the average of age during the appearance of the venous lesions was 40 years. Arterial lesions appear more late in 13 patients (43 %) (average of age 43 years). We noted, on the other hand, 11 cases of aneurysms and five cases of arterial thrombosis. The use of corticosteroids was necessary in all cases in association with the others drugs (anticoagulants, colchicine, immunosuppressors). Among the patients having had aneurysms, six were treated surgically. The outcome was favorable for most patients. Two patients had pulmonary embolism and two post-surgery complications. One patient died in the consequences of an intragastric break of an aneurysm of the abdominal aorta. CONCLUSION The vascular involvement in Behcet's disease is manifested primarily by thrombophlebitis. Achieving blood pressure, less common, is problematic therapeutic because of the recurrent and life threatening.
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Abstract
Behçet's disease is a chronic multi-system inflammatory disorder and the severity and clinical manifestations of Behçet's patients may show geographic variation. We aimed to detect the cardiac findings in 30 Behçet's patients and compare them with the normal population (n = 29). We used color-doppler echocardiography and transesophageal echocardiography in combination. We calculated manually QT intervals and QT dispersion (QTd) from twelve-lead ECG recordings. There was no E/A inversion and coronary ischemia in all patients or control group. The E velocity difference between groups was not significant. The mean A velocity was significantly lower in Behçet's patients than normal group. The mean DT was 154.4 +/- 5.8 msec in Behçet's patients and 122.59 +/- 0.96 msec in control group (P < 0.0001). The mean IVRT was 75.66 +/- 1.36 msec in Behçet's patients and 69.1 +/- 0.55 msec in control group (P < 0.0001). There was no QTc time difference between the Behçet's patients and the control group. The mean QT dispersion (QTd) interval was 45.46 +/- 2.65 msec in Behçet's patients and 31.83 +/- 1.23 msec in control group (P < 0.0001). Atrial septal aneurysm, mitral valve prolapse and insufficiency, tricuspid valve insufficieny, and pulmonary hypertension frequencies in Behçet's patients were significantly higher than in the control group. We concluded that Behçet's cardiac involvement may effect cardiac structure and cause diastolic dysfunction, electrical instability and structural abnormalities. We also concluded that cardiac involvement in Behçet's disease may be specific for this geographic area.
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Chiu HH, Wang SS, Wu MH, Wang JK. Aortitis with severe aortic regurgitation in Behcet's disease: a case report. J Formos Med Assoc 2010; 109:82-4. [PMID: 20123590 DOI: 10.1016/s0929-6646(10)60025-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Behcets aortitis is a rare, but one of the most severe complications of Behcets disease. We report a 24-year old woman who was noted initially to have aortitis and severe aortic regurgitation caused by Behcets disease. After receiving aortic valve replacement, aortoplasty and immunosuppressant therapy, her condition became stationary. As far as we are aware, she is the youngest case that has undergone surgery. The early onset of hemodynamic decompensation is considered to be related to delay in diagnosis and lack of steroid treatment.
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Affiliation(s)
- Hsin-Hui Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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Alkaabi JK, Pathare A. Pattern and outcome of vascular involvement of Omani patients with Behcet’s disease. Rheumatol Int 2010; 31:731-5. [DOI: 10.1007/s00296-010-1363-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 01/16/2010] [Indexed: 11/24/2022]
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Varol A, Seifert O, Anderson CD. The skin pathergy test: innately useful? Arch Dermatol Res 2009; 302:155-68. [PMID: 20012749 DOI: 10.1007/s00403-009-1008-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 11/02/2009] [Accepted: 11/10/2009] [Indexed: 12/11/2022]
Abstract
Pathergy is the term used to describe hyper-reactivity of the skin that occurs in response to minimal trauma. A positive skin pathergy test (SPT), characterised by erythematous induration at the site of the needle stick with a small pustule containing sterile pus at its centre, is among the criteria required for a diagnosis of Behçet's disease (BD) and in certain population has been shown to be highly specific for this condition. Problems with standardising the induction manoeuvre for the SPT as well as the method of assessment of the response have limited the usefulness of the SPT in the clinical setting. Extensive investigation into histopathological and immunological aspects of pathergy has led to a number of hypotheses relating to the aetiology of the skin pathergy reaction and the disease itself, but the cause is considered to be unknown. Pathergy lesions, the development of new skin lesions or the aggravation of existing ones following trivial trauma, are also reported in pyoderma gangrenosum and has been noted in other neutrophilic dermatoses such as Sweet's syndrome. The response of such patient groups to the systematic application of the SPT has not been described. We propose that a new way of considering the pathergy reaction is to see it as an aberration of the skin's innate reactivity from a homeostatic reactive mode closely coupled to tissue healing to an abnormal destructive/inflammatory mode. Our understanding of BD and other similar conditions would profit by more detailed mechanistic knowledge of skin homeostasis to minimal trauma in both health and disease through a more structured and systematic use of the SPT.
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Affiliation(s)
- Alexandra Varol
- Department of Dermatology, Liverpool Hospital, Sydney, Australia
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Jeong DS, Kim KH, Kim JS, Ahn H. Long-Term Experience of Surgical Treatment for Aortic Regurgitation Attributable to Behçet's Disease. Ann Thorac Surg 2009; 87:1775-82. [PMID: 19463593 DOI: 10.1016/j.athoracsur.2009.03.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2009] [Revised: 03/09/2009] [Accepted: 03/09/2009] [Indexed: 10/20/2022]
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Porcu P, Chavanon O, Bertrand B, Costache V, Carley H, Bach V, Hacini R, Blin D. Giant aneurysm of the proximal segment of the left anterior descending artery in a patient with Behçet's disease--a combined approach. Can J Cardiol 2008; 24:e73-4. [PMID: 18841264 DOI: 10.1016/s0828-282x(08)70690-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Behçet's disease is an autoimmune, multisystem disease presenting with recurrent oral and genital ulceration as well as ocular involvement. Aneurysmal degeneration of coronary arteries remains a rare phenomenon in Behçet's disease. The case of a patient with Behçet's disease who presented with severe stenosis of the left anterior descending artery associated with a giant aneurysm of the proximal segment is described. Surgical revascularization was proposed, followed by percutaneous embolization of the aneurysm.
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Affiliation(s)
- Paolo Porcu
- Department of Cardiac Surgery, Grenoble University Hospital, Grenoble, France
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Kaya E, Saglam H, Ciftci I, Kulac M, Karaca S, Melek M. Evaluation of myocardial perfusion and function by gated SPECT in patients with Behçet's disease. Ann Nucl Med 2008; 22:287-95. [PMID: 18535879 DOI: 10.1007/s12149-007-0115-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 12/13/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Behçet's disease (BD) is a systemic multi-system vasculitis that can have a wide range of effects on the cardiovascular system. OBJECTIVE To determine the existence of myocardial perfusion defects caused by coronary microvascular dysfunction in BD and to evaluate coronary arterial distribution and left ventricular systolic function by gated single-photon emission computed tomography (SPECT). METHODS The study population consisted of 23 (15 men and 8 women) patients with BD and 20 healthy controls (12 men and 8 women). Technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) gated SPECT studies were performed at stress and rest in a 2-day protocol. Stress and rest left ventricular ejection fraction (LVEF) were calculated. Using non-gated SPECT images myocardial perfusion scores [summed stress score (SSS), summed rest score (SRS), summed difference score (SDS), and fix defect score (FDS)] and perfusion defect extent as percentage (stress, rest ischemic, and fix %LV) were determined. Using gated SPECT images, wall motion score indices (stress wall motion score indices and rest wall motion score indices) were calculated. Coronary angiography (CAG) was applied to patients with abnormal myocardial perfusion scintigraphy (MPS). RESULTS The mean ages of the BD and control groups were 39.3 +/- 10.6 years and 36.2 +/- 8.3 years, respectively. No statistically significant differences were observed between the two groups regarding clinical features and cardiologic findings. Abnormal MPS was found in 13 (56.5%) of the BD patients; 3 patients had non-transmural infarcts and 10 patients reversible perfusion defects. Reversible perfusion defects were also found in two controls (10.0%). When the two groups were compared regarding the gated SPECT findings, differences were determined in the following parameters; SSS, SRS, SDS, FDS, stress and rest LVEF, stress and rest %LV, and stress and rest WMSI. In the BD group, when gated SPECT results were compared between those with and without abnormal MPS, differences were determined in SSS, SRS, SDS, FDS, stress and rest %LV, and stress and rest WMSI. Epicardial coronary arteries were normal in CAG. CONCLUSIONS Myocardial perfusion and function are disturbed owing to influenced coronary microvascularity in BD, and CAG is frequently observed to be normal. Gated SPECT is a non-invasive reliable method that simultaneously evaluates the existence, extent and severity of myocardial ischemia or infarction and the wall movements in cardio-Behçet.
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Affiliation(s)
- Eser Kaya
- Department of Nuclear Medicine, Faculty of Medicine, Afyon Kocatepe University, Inönü Bulvari, Afyonkarahisar, Turkey.
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Yoshikawa K, Hori H, Fukunaga S, Tayama E, Aoyagi S. Aortic root replacement in Behçet disease. Asian Cardiovasc Thorac Ann 2008; 15:521-3. [PMID: 18042781 DOI: 10.1177/021849230701500616] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The patient presented with a history of recurrent aphthous stomatitis, genital ulceration, and a family history of positive for collagen disease. Echocardiography and retrograde aortography revealed aneurysm formation of the sinus of Valsalva, and dilatation of the aortic valve annulus with severe aortic regurgitation. On diagnosis of an aneurysm of the sinus of Valsalva and aortic regurgitation associated with Behçet's disease, aortic root replacement with the modified Bentall technique was successfully performed.
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Affiliation(s)
- Kazuhiro Yoshikawa
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
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Kalko Y, Basaran M, Aydin U, Kafa U, Basaranoglu G, Yasar T. The surgical treatment of arterial aneurysms in Behçet disease: A report of 16 patients. J Vasc Surg 2005; 42:673-7. [PMID: 16242553 DOI: 10.1016/j.jvs.2005.05.057] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Accepted: 05/08/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this article is to report our experience in the surgical treatment of arterial aneurysms in patients with Behçet disease. METHODS From October 2001 through May 2004, 18 arterial aneurysms were diagnosed in 16 Behçet patients. All patients were male. The patients ranged in age from 24 to 52 years (mean, 37.4 +/- 5.2 years). There were six abdominal aortic, three common femoral, two iliac, two popliteal, two superficial femoral, and two anterior tibial aneurysms and one subclavian artery aneurysm. All patients but four were in remission at the time of diagnosis. Those 4 patients received immunosuppressive therapy before the surgical intervention to induce remission. After hospital discharge, all patients were followed up regularly at 3-month intervals. The mean duration of follow-up was 17 +/- 4.2 months (range, 6-24 months). RESULTS All patients underwent a successful surgical intervention. During the study period, we performed five aortic tube graft interpositions, two aortofemoral bypasses, one aortobifemoral bypass, three common femoral artery graft interpositions, and two femoropopliteal bypasses. The popliteal artery (n = 2), anterior tibial artery (n = 2), and subclavian artery (n = 1) aneurysms were repaired primarily. There was no in-hospital mortality. One patient with an abdominal aortic aneurysm had to undergo reoperation because of postoperative bleeding. The postoperative hospital stay was 8.5 +/- 4.3 days. Two patients were lost to follow-up. During the follow-up period, two false aneurysms of the common femoral artery were repaired with a graft interposition procedure. Another patient who had undergone an aortic tube graft interposition was readmitted 9 months later with an external iliac artery aneurysm. The external iliac artery was ligated through a retroperitoneal approach, and femorofemoral bypass was performed. In addition, one femoropopliteal interposition graft was occluded, without disabling ischemia. CONCLUSIONS Although aneurysmal disease is rare in Behçet disease, it can complicate the clinical picture and cause life-threatening complications. We believe that the establishment of remission before the surgical intervention decreases the incidence of postoperative complications. Because recurrence at the site of anastomosis is possible, prolonged monitoring is required.
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Affiliation(s)
- Yusuf Kalko
- Department of Cardiovascular Surgery, Vakif Gureba Hospital, Istanbul, Turkey.
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Coskun B, Oztürk P, Saral Y. Are erythema nodosum-like lesions and superficial thrombophlebitis prodromal in terms of visceral involvement in Behcet's disease? Int J Clin Pract 2005; 59:69-71. [PMID: 15707468 DOI: 10.1111/j.1742-1241.2005.00286.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Erythema nodosum (EN)-like lesions and superficial thrombophlebitis (ST) are skin symptoms that are frequently observed in Behcet's disease. In most of the patients, skin symptoms precede serious visceral involvement. The study included 78 patients whose mean age was 33.48 +/- 6.16 (21-48). Of the cases, 37 were females and 41 were males. Forty-two patients (53.8%) had EN-like lesion and 12 (15.3%) had ST. Six of 54 patients, who had EN-like lesion and ST, were found to have no visceral involvement. In six of the remaining 48 patients, it was established that visceral involvement developed before lesions. It was found in 42 patients that these two lesions preceded visceral involvement. In addition, 18 of 24 patients who did not have these two lesions, do not still have visceral involvement. Therefore, we think that EN-like lesion and ST can be guiding in predicting serious visceral involvement and complications that can develop in advanced stages of Behcet's disease.
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Affiliation(s)
- B Coskun
- Department of Dermatology, Faculty of Medicine, Firat University, Elazig, Turkey.
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Tohmé A, Aoun N, El-Rassi B, Ghayad E. Vascular manifestations of Behçet's disease. Eighteen cases among 140 patients. Joint Bone Spine 2004; 70:384-9. [PMID: 14563470 DOI: 10.1016/s1297-319x(03)00076-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To describe the features, prognosis, and treatment of vascular involvement in Behçet's disease (BD). PATIENTS Among 140 patients with BD seen at the Hôtel-Dieu Hospital in Beirut between 1980 and 2000, 18 (13%) had vascular involvement and were included in this retrospective study. All these patients fulfilled International Study Group criteria for BD. RESULTS Men with BD were more likely to have vascular involvement (13/77, 17%) than women (5/63, 8%) (P = 0.12) and were younger at diagnosis of vascular disease (32 +/- 7 vs. 36 +/- 7.5 years; P < 0.01). Many patients had vascular disease at more than one site: 17 had thrombophlebitis, 10 had arterial thromboses, and one had an aneurysm. Thrombophlebitis was more common in men (82% vs. 18%; P < 0.03) and arterial occlusion in women (70% vs. 30%; P > 0.05). Caval thrombosis and arterial occlusions were the most serious complications. Combined treatment with glucocorticoids, anticoagulants, and immunosuppressants was effective in superior vena cava syndrome and extracranial arterial occlusion. CONCLUSION Vascular manifestations of BD are common in Lebanon, particularly venous lesions. Aneurysms are seen less often than arterial occlusions. Medical treatment may be sufficient in superior vena cava syndrome and arterial occlusion.
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Affiliation(s)
- Aline Tohmé
- Department of Internal Medicine, Hôtel-Dieu de France Hospital of Beirut, School of Medicine, Saint Joseph University of Beirut, rue Adib Ishaac, Beirut, Lebanon.
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Abstract
Complex aphthosis is a disorder in which patients develop recurrent oral and genital aphthous ulcers or almost constant, multiple oral aphthae, without manifestations of systemic disease. Behçet's disease is a multisystem disease characterized clinically by oral and genital aphthae, arthritis, cutaneous lesions, and ocular, gastrointestinal, and neurologic manifestations. This article reviews both disorders, including their clinical and histologic presentations, factors in pathogenesis, and includes an overview of therapeutic modalities.
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Affiliation(s)
- Martha Ann McCarty
- Department of Dermatology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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Eryol NK, Topsakal R, Abaci A, Oğuzhan A. A case of atrioventricular complete block due to Behçet's disease. JAPANESE HEART JOURNAL 2002; 43:697-701. [PMID: 12558133 DOI: 10.1536/jhj.43.697] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The cardiovascular system is involved in 5% of the cases of Behçet's disease. Thrombophlebitis. aneurysm in arteries, pericarditis, myocarditis, valvular disease, ventricular arrhythmia, and conduction system disorders may occur. A case of Behçet's disease with complete proximal atrioventricular block is presented.
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Affiliation(s)
- Namik Kemal Eryol
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Basaran Y, Degertekin M, Direskeneli H, Yakut C. Cardiac thrombosis in a patient with Behçet's disease: two years follow-up. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 2000; 16:377-82. [PMID: 11215922 DOI: 10.1023/a:1026584409912] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A 28-year-old man with Behçet's disease was presented with cardiac symptoms in addition to previous complaints of oral and genital ulcers. A diagnosis of thrombosis was made and patient began to receive anticoagulant and immunosuppressive therapy and was followed by echocardiographic examination. Despite medical therapy, thrombosis recurred. Surgical excision was performed and histological findings were consistent with organizing thrombus. Nature of cardiac involvement and review of literature on cardiac thrombosis in Behçet's disease was discussed.
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Affiliation(s)
- Y Basaran
- Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
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López-Gómez D, Shaw E, Alió J, Cequier A, Castells E, Esplugas E. [Right ventricular outflow obstruction due to a giant pseudoaneurysm of the anterior descending coronary artery in a patient with Behçet's disease]. Rev Esp Cardiol 2000; 53:297-9. [PMID: 10734763 DOI: 10.1016/s0300-8932(00)75095-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Giant pseudoaneurysms of coronary arteries in patients with Behçet's disease is a uncommon finding. It has been described exceptionally in the literature. We present a case of giant pseudoaneurysm of the left anterior descending coronary artery with obstruction of the right ventricular outflow in a patient with Behçet's disease. He improved after surgical resection and steroid treatment.
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Affiliation(s)
- D López-Gómez
- Servicio de Cardiología, Ciudad Sanitaria y Universitaria de Bellvitge, L'Hospitalet de Llobregat, Barcelona
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Pericarditis constrictiva y enfermedad de Behçet: una asociación muy infrecuente. Rev Esp Cardiol (Engl Ed) 1999. [DOI: 10.1016/s0300-8932(99)74895-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Roguin A, Edoute Y, Milo S, Shtiwi S, Markiewicz W, Reisner SA. A fatal case of Behçet's disease associated with multiple cardiovascular lesions. Int J Cardiol 1997; 59:267-73. [PMID: 9183042 DOI: 10.1016/s0167-5273(97)02939-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Behçet's disease is recognised as a chronic multisystem disorder with vasculitis as its underlying pathological process. Cardiac involvement is rare and often associated with poor prognosis. A large right atrial thrombus, pulmonary aneurysms and aortic pseudoaneurysm that developed 17 years after surgery for bilateral renal artery stenosis is presented in a 26-year-old Behçet's disease patient. He was admitted to the hospital with fever of unknown origin associated with chest pain, dyspnea, cough, haemoptysis and pulmonary opacity in chest X-ray. Initial pulmonary CT demonstrated small subpleural infiltrates bilaterally, one of which was round and suspected as being metastatic. Examination of open lung biopsy demonstrated haemorrhagic infarct surrounded by some occluded pulmonary arteries. Subsequent CT showed pulmonary aneurysms compatible with Behçet's disease. Echocardiography demonstrated a large pedunculated mass in the right atrium. Injection of urographin showed a right atrial mass and a large right pulmonary artery aneurysm. The atrial mass was completely excised during open heart surgery and was identified as being an organising thrombus. Eight weeks later while taking prednisone, he was readmitted because of an infected mid sternal wound. CT showed slight separation of the stemum, retrosternal fluid, pulmonary arteries aneurysm and ascending aorta aneurysm. The next day, the patient died from massive bleeding from his ruptured ascending aortic pseudoaneurysm. Bizarre presentation of arterial and venous thromboses or arterial aneurysm formation, particularly in young patients, should suggest Behçet's disease.
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Affiliation(s)
- A Roguin
- Department of Cardiology, Rambam Medical Centre, Technion Faculty of Medicine, Haifa, Israel
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Geist C, Wöhrmann T, Schneider J, Zwingenberger K. Effects of thalidomide on the local Shwartzman reaction in mice and rabbits. FEMS IMMUNOLOGY AND MEDICAL MICROBIOLOGY 1995; 12:165-74. [PMID: 8745000 DOI: 10.1111/j.1574-695x.1995.tb00189.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The Shwartzman reaction is an animal model displaying histopathological vasculitis phenomena. Extravasation and swelling due to increased vascular permeability and cellular infiltration, which are hallmarks of the Shwartzman reaction, were evaluated as leakage of i.v.-injected Evans Blue dye and by histological and immunohistological characteristics in rabbits and mice. (+/-)-Thalidomide, (-)-thalidomide, (+)-thalidomide and dexamethasone inhibited the increase of vascular permeability in the local Shwartzman reaction. Histologically, the intensity of the Shwartzman reaction was reduced. In mice thrombus formation and leukocytoclastic vasculitis was inhibited by (+/-)-thalidomide and (+)-thalidomide. ICAM-1 expression was markedly reduced after (+)-thalidomide injection. Thalidomide and dexamethasone pretreatment reduced Mac-1 expression on perivascular infiltrated granulocytes. The inhibitory effect of thalidomide on vasculitis of the Shwartzman reaction may thus be related to reduction of adhesion molecule expression.
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Affiliation(s)
- C Geist
- Grunenthal GmbH, Center of Research, Aachen, Germany
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Abstract
Behçet syndrome is a systemic disease rather than the initial more narrowly characterized triple symptom-complex of recurrent oral and genital ulcers and chronic iridocyclitis. Major cardiac and pulmonary manifestations of the disease are relatively uncommon and their pathologic features have seldom been documented. Described herein is a fatal case of Behçet syndrome with co-existing myocarditis, pulmonary thromboangiitis, and pulmonary artery aneurysms.
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Affiliation(s)
- J T Lie
- Department of Pathology, Mayo Clinic, Rochester, Minnesota
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Salamon F, Weinberger A, Nili M, Avidor I, Neuman M, Zelikovsky A, Levy MJ, Pinkhas J. Massive hemoptysis complicating Behçet's syndrome: the importance of early pulmonary angiography and operation. Ann Thorac Surg 1988; 45:566-7. [PMID: 3365050 DOI: 10.1016/s0003-4975(10)64538-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A 16-year-old patient with Behçet's syndrome had massive hemoptysis due to a ruptured aneurysm of a segmental artery of the left lung. Emergency left lower lobectomy was performed. The patient is well 12 months after operation. There have been no further episodes of hemoptysis.
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Affiliation(s)
- F Salamon
- Department of Internal Medicine D, Beilinson Medical Center, Petah Tikva, Israel
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Or I, Roguin N, Yahalom M, Birjiniuk V, Amikam S. Pacemaker implantation in a patient with a Behçet's disease associated with superior vena cava obstruction. Cardiovasc Intervent Radiol 1986; 9:13-4. [PMID: 3085933 DOI: 10.1007/bf02576975] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A 65-year-old man with Behçet's disease developed transient complete A-V block with syncope. An attempt to implant a permanent transvenous endocardial electrode failed owing to obstructions in the subclavian, innominate, and superior vena cava veins demonstrated by angiography. Sutureless epicardial electrodes were successfully implanted through a subxyphoid approach. Obstruction in the great veins is a common feature in patients with Behçet's disease. We suggest that patients with this disorder, who require a permanent pacemaker, should be investigated by angiography prior to implant to rule out obstruction in the upper great veins.
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Peńa JM, Garcia-Alegria J, Garcia-Fernandez F, Arnalich F, Barbado FJ, Vazquez JJ. Mitral and aortic regurgitation in Behçet's syndrome. Ann Rheum Dis 1985; 44:637-9. [PMID: 4037889 PMCID: PMC1001724 DOI: 10.1136/ard.44.9.637] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A 35-year-old man with definite Behçet's disease developed acute mitral and aortic regurgitation. Valvular disease, we believed, was another manifestation of this disease. Cardiac involvement in Behçet's disease and the role of prednisone therapy are discussed.
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Abstract
Valve prolapse was diagnosed solely by echocardiography in three consecutive patients with Behçet's disease. Two patients had prolapse of the posterior mitral valve leaflet, but no clinical manifestations of valve prolapse. In the third patient aortic valve prolapse was associated with physical signs of aortic regurgitation and left ventricular failure. Valve prolapse in these cases may have resulted from structural and functional derangement caused by the underlying non-specific vasculitis that occurs in Behçet's disease.
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