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Ahn BH, Jung Y, Hwang HY, Oh SG, Lee KS, Choi JW. Aortic Valve Replacement by Subannular Endomyocardial Implantation of Valve Prosthesis in Behçet's Disease. Ann Thorac Cardiovasc Surg 2023. [PMID: 37062720 DOI: 10.5761/atcs.cr.22-00231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
The novel anastomosis technique, "subannular endomyocardial implantation of valve prosthesis (SEIV)," focuses on excluding aortic annular tissue from suture line to avoid vascular inflammation in Behçet's disease (BD). We aimed to validate that SEIV could prevent prosthetic valve detachment (PVD) after aortic valve replacement (AVR) in BD patients and retrospectively analyzed the medical records of five BD patients who underwent AVR. There was no operative death. Two complete atrioventricular blocks occurred; in one of them, a permanent pacemaker (PPM) was inserted before discharge. The other one was discharged without a PPM; however, he died suddenly 32 days postoperatively. The median follow-up period was 3.3 years. There was a case of PVD with newly developed Valsalva sinus aneurysm requiring the Bentall operation at 3.6 years postoperatively. In conclusion, SEIV might prevent PVD in BD patients who underwent AVR. However, aortic root pathology related to BD activity and resulting PVD may occur later.
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Affiliation(s)
- Byoung Hee Ahn
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Republic of Korea
| | - Yochun Jung
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Gi Oh
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Republic of Korea
| | - Kyo Seon Lee
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Republic of Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Li X, Wen X, Xu J, Lin Q, Liu L. Prognostic analysis of Behçet's disease with aortic regurgitation or involvement. Neth Heart J 2021; 30:172-180. [PMID: 33877589 PMCID: PMC8881513 DOI: 10.1007/s12471-021-01567-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/29/2022] Open
Abstract
Background Aortic regurgitation is the most common cardiovascular damage in Chinese patients with Behçet’s disease (BD) and is usually associated with aortic disease. These patients are easily misdiagnosed, and their prognosis is poor, even after surgical treatment. This study aimed to analyse potential factors that can improve the prognosis of BD patients with aortic regurgitation and/or aortic involvement. Methods Twenty-two patients with diagnosed or suspected BD as well as aortic regurgitation and/or aortic involvement in our hospital from 2012 through 2017 were collected in this study. Their clinical characteristics were listed, and the diagnosis of BD was evaluated by two different criteria sets. The influences of surgical treatment and immunosuppressive therapy (IST) on their prognosis were also explored. Results The diagnostic positive rate of the International Criteria for Behçet’s Disease was higher than that of the International Study Group criteria (kappa value 0.31, p < 0.05), indicating that the diagnostic consistency between the criteria sets was poor. There was no significant difference in survival between patients who had undergone ≤ 1 operation and those with ≥ 2 operations. Aortic valve replacement alone or in combination with aortic root replacement had no significant effect on the incidence of reoperation or death, but IST did significantly reduce this incidence (p < 0.05). However, there was no significant difference in the occurrence of reoperation or death between preoperative and postoperative IST versus postoperative IST only. Conclusion IST significantly improved the prognosis of BD patients with aortic regurgitation and/or aortic involvement. Supplementary Information The online version of this article (10.1007/s12471-021-01567-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- X Li
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, Hunan, China.,Modern Cardiovascular Disease Clinical Technology Research Centre of Hunan Province, Changsha, Hunan, China.,Cardiovascular Disease Research Centre of Hunan Province, Changsha, Hunan, China
| | - X Wen
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - J Xu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, Hunan, China.,Modern Cardiovascular Disease Clinical Technology Research Centre of Hunan Province, Changsha, Hunan, China.,Cardiovascular Disease Research Centre of Hunan Province, Changsha, Hunan, China
| | - Q Lin
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, Hunan, China.,Modern Cardiovascular Disease Clinical Technology Research Centre of Hunan Province, Changsha, Hunan, China.,Cardiovascular Disease Research Centre of Hunan Province, Changsha, Hunan, China
| | - L Liu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China. .,Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, Hunan, China. .,Modern Cardiovascular Disease Clinical Technology Research Centre of Hunan Province, Changsha, Hunan, China. .,Cardiovascular Disease Research Centre of Hunan Province, Changsha, Hunan, China.
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Pólos M, Koppányi Á, Benke K, Daróczi L, Oláh A, Heltai K, Kiss E, Fintha A, Nagy B, Hartyánszky I, Lakatos B, Kovács A, Merkely B, Szabolcs Z. Behçet's disease: successful aortic root reconstruction in severely dilated aortoventricular junction after aortic valve replacement with novel surgical method - case report. J Cardiothorac Surg 2021; 16:85. [PMID: 33858452 PMCID: PMC8048072 DOI: 10.1186/s13019-021-01467-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 04/05/2021] [Indexed: 11/21/2022] Open
Abstract
Background Behçet’s disease is an auto-inflammatory disorder categorized as a primer systemic vasculitis of unknown aetiology. Genetic factors, infectious agents and the irregularity of T-cell homeostasis are presumed to be responsible for the emergence of Behçet’s disease. Characteristic symptoms are multisystemic. Although cardiovascular involvement is rare, it should be noted due to the difficulty of surgical treatment options. Case presentation Our 44-year-old male patient underwent aortic valve replacement due to aortic regurgitation. At the 15-month follow-up, echocardiography showed detachment of the prosthetic valve and in the aortic root, multiple pseudo-aneurysms were identified. We performed an aortic root reconstruction with a Bentall procedure using a special „skirted” conduit to reduce strain in the suture line between the conduit and the extremely dilated left ventricular outflow tract. Conclusions The surgical treatment of cardiovascular manifestations of Behçet’s disease remains challenging. This new technique may be beneficial in well-selected cases where the annulus of the aorta is extremely dilated or annular tissue disorder is present.
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Affiliation(s)
- Miklós Pólos
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary.
| | - Ádám Koppányi
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
| | - Kálmán Benke
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
| | - László Daróczi
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
| | - Attila Oláh
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
| | - Krisztina Heltai
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
| | - Emese Kiss
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Attila Fintha
- First Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Beáta Nagy
- First Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - István Hartyánszky
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
| | - Bálint Lakatos
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
| | - Attila Kovács
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
| | - Béla Merkely
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
| | - Zoltán Szabolcs
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
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Lee CH, Je HG, Ju MH. Modified Bentall procedure with a rapid deployment valve in cardiac Behçet's disease: A case report. JTCVS Tech 2020; 2:43-45. [PMID: 34317746 PMCID: PMC8298923 DOI: 10.1016/j.xjtc.2020.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 02/13/2020] [Accepted: 03/13/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | - Min Ho Ju
- Address for reprints: Min Ho Ju, MD, Department of Cardiovascular and Thoracic Surgery, Pusan National University Yangsan, Hospital, Yangsan, Gyeongnam, South Korea 626-770.
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D'Alessandro S, Nicolini F, Formica F. Commentary: A novel surgical strategy for aortic valve replacement in Behçet's disease: Is this the new Silk Road? JTCVS Tech 2020; 2:48-49. [PMID: 34317748 PMCID: PMC8298920 DOI: 10.1016/j.xjtc.2020.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 03/08/2020] [Accepted: 03/11/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Stefano D'Alessandro
- Cardiac Surgery Unit, Department of Medicine and Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Francesco Nicolini
- Cardiac Surgery Unit, Department of Medicine and Surgery, Parma General Hospital, University of Parma, Pharma, Italy
| | - Francesco Formica
- Cardiac Surgery Unit, Department of Medicine and Surgery, Parma General Hospital, University of Parma, Pharma, Italy
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Antunes MJ. Commentary: Treatment of aortic regurgitation in Behçet's disease: More than one way to skin a cat. JTCVS Tech 2020; 2:46-47. [PMID: 34317747 PMCID: PMC8298913 DOI: 10.1016/j.xjtc.2020.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Manuel J. Antunes
- Address for reprints: Manuel J. Antunes, MD, PhD, DSc, Faculty of Medicine, University of Coimbra, 3000-075, Coimbra, Portugal.
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