Stenosis and aneurysm of coronary arteries in a patient with Behçet's Disease

Recurrent left main stem stenosis in a young female with Behçet's aortitis: a case report

Background

Behçet's disease (BD) is a rare and complex vasculitis disorder renowned for its diverse clinical presentations. Cardiovascular involvement is reported to be present in 7-46% of the patients, with coronary arteries being involved in only 0.5%. The management of cardiovascular complications can be challenging due to the rarity of such cases and the absence of standardized guidelines regarding diagnosis and treatment.

Case summary

We report the case of a 27-year-old patient with BD with known aortitis and pulmonary arteritis, who presented with recurrent acute coronary syndromes related to critical left main coronary artery stenosis. She was initially managed with percutaneous coronary interventions twice. Following recurrent stent failure, she eventually underwent urgent coronary artery bypass surgery, together with aortic valve replacement and aortic root repair. She made an uneventful recovery and remains well 6 months following her operation.

Discussion

This case illustrates the significant challenges that can be encountered when managing coronary complications in patients with BD. Both percutaneous and surgical options have been reported in the literature with variable outcomes. Multi-disciplinary team involvement is of utmost importance in order to offer a balanced therapeutic strategy to these patients. Further research is required to shed light to the unknowns surrounding this rare cohort.

Numerical simulation of the blood flow through a pre-stenotic aneurysm in coronary artery: effects of varying heart rate

The left anterior descending artery (LAD) is a significant coronary artery and a facilitator of oxygenated blood to the heart muscles. Thus, any occurrence of an aneurysm in LAD requires immediate medical attention. It is often inclined toward fatality if coupled with a blockage due to stenosis. Given the high relevance of understanding such models, invasive techniques under all parametric circumstances are hard to achieve. So, a theoretical approach with a cost-effective intervention of mathematical modeling becomes essential. In our current work, we analyze the model with the numerical technique of a modified form of SIMPLE pressure-correction based algorithm and perform parametric studies for the flow field with degree of stenosis, degree of aneurysm, heart rate, and distance separating aneurysm and stenosis as parameters. The study reveals a direct proportionality relation between the number of recirculation zones and heart rate through instantaneous streamline plots. Alongside this, the demonstration of an increase in the risk of rupture of the aneurysm with a decrease in the distance between stenosis and aneurysm, using the physical parameters associated with blood flow, is another key finding. Further, we examine the effect of the flow field on heat transfer and the consequent temperature profiles.

OUP accepted manuscript

The impact of long-standing human immunodeficiency virus infection (HIV) and potent anti-retroviral therapy on the coronary circulation is unknown; however, scattered reports are emerging of coronary aneurysms in this population. We report what we believe to be the first described case of both coronary stenosis and coronary artery aneurysms in a person living with HIV and discuss management options.

Getting to the <em>heart</em> of the matter: diagnostic tools and therapeutic approach to cardiac involvement in Behçet syndrome A Tunisian case series

The aim was to investigate the frequency and spectrum of cardiac involvement (CI) in patients with Behçet syndrome (BS) in the Tunisian context, and to assess the clinical and imaging features, treatment, and outcomes. We retrospectively retrieved the medical records of patients with CI among 220 BS patients admitted to the hospital internal medicine department between February 2006 and April 2019, who fulfilled the International Study Group diagnostic criteria for BS. Ten patients (8 men, 2 women) were eligible for the study. Mean age was 37.3 years. Three patients had 2 isolated episodes of cardiac BS. The different types of CI were coronary artery disease (5/10), intracardiac thrombus (4/10), pericarditis (1/10), myocarditis (1/10), and myocardial fibrosis (1/10). Five patients had associated vascular involvement (50%). Medical treatment was based on corticosteroids and colchicine in all patients (100%), anticoagulants in 8 (80%), and cyclophosphamide followed by azathioprine in 9 (90%). The clinical course was favorable in 9 patients; 1 patient died. CI remains an important feature of BS because of its association with increased risk of mortality and morbidity. Therefore, early screening and detection with imaging methods are paramount. Also, better cooperation between rheumatologists and cardiologists could improve outcomes.

Acute coronary syndrome in Behcet's syndrome: A systematic review

Behcet syndrome is a rare vasculitis that affects both arteries and veins. Vasculo-Bechet Syndrome (VBS) is seen predominantly in men. Genetic predisposition and immune dysregulation leading to inflammation, endothelial damage, and impaired fibrinolysis contribute to its pathogenesis. Isolated case reports of Behcet syndrome (BS) with associated acute coronary syndrome (ACS) have been reported in the past. In this study, we present the first systematic review of such cases. A systematic search was conducted using Pubmed, Google Scholar, CINAHL, Cochrane CENTRAL, and Web of Science databases from 1980-2018 to identify case reports of myocardial infarction associated with BS. Cases that fulfilled the criteria for BS were selected for analysis. Demographic data, electrocardiography, echocardiography, angiography findings, and management were analyzed when available. We identified 62 case reports. Most subjects were men with a mean age of 37 years. Twenty-one percent were smokers, but other traditional cardiovascular risk factors were less common. Myocardial infarction was confirmed in half of the cases with findings on electrocardiogram (ECG). Echocardiogram revealed wall motion abnormality in 76% of patients, and angiography showed double-vessel disease in more than half of the cases. Mortality was reported in 1.6% of the cases. This systematic review shows that ACS in BS affects young males with low prevalence of coronary artery disease risk factors. Chest pain is the most common presenting feature and ST-segment elevation myocardial infarction (STEMI) was the most common ECG finding. Immunotherapy may be helpful to prevent future ACS in these patients.

Cardiac findings in patients with Behçet's disease: Facts and controversies

Behçet’s disease (BD) is a systemic vasculitis of unknown etiology. It is characterized by recurrent oral and genital ulcers, uveitis, and a number of systemic manifestations. Although the disease is recognized worldwide, its prevalence is highly variable. A detailed review and analysis of the worldwide published reports on BD showed that not only the prevalence of the disease but also its cardiac complications differ according to the geographic distribution of the studied population. With the exception of France, Greece, Spain, and Italy, very few reports and studies regarding BD have been published from the western countries. Cardiovascular complications are an important cause of poor outcome in patients with BD. Over the past few years, many case reports and studies have been published, providing more facts about these complications. For example, peculiar echocardiographic findings in patients with aortic valve regurgitation and intracardiac thrombi secondary to BD were recently described. The role of these findings in the initial diagnosis of the disease, however, remains to be evaluated. On the other hand, some reports present contradictory results, especially concerning the left ventricular diastolic function, pathogenesis of coronary artery disease, and proper management of the cardiac complications in BD. Importantly, management of these complications is based mainly on the discretion of the treating physician due to the absence of large controlled studies and clear guidelines. This approach sometimes creates inconsistent data and allows controversies to persist. The review presented here will discuss some of the facts and controversies related to cardiac complications in BD.

CT coronary angiography findings in non-atherosclerotic coronary artery diseases

Non-atherosclerotic coronary artery diseases are being increasingly recognised as causes of acute coronary events. Invasive coronary angiography frequently fails to identify the abnormalities in the proximal course of coronary arteries and coronary wall, while computed tomography coronary angiography (CTCA) allows for acquisition of more detailed information. CTCA serves as a reliable method for evaluating patients with non-atherosclerotic coronary artery diseases. The purpose of this article is to provide an overview of non-atherosclerotic abnormalities that may be demonstrated on CTCA.

Successful Stent Implantation for Aortoiliac Bifurcation Stenosis in a Young Patient with Behçet's Disease

Behçet's disease (BD) is a multisystem vascular inflammatory disease. BD can affect blood vessels of nearly all sizes and types. Arterial involvement is a rare but serious condition in the course of BD. Here, we report a case of stenosis at the iliac artery bifurcation which was treated with percutaneous balloon angioplasty and stent implantation in a 37-year-old patient with BD.

Stenting for huge coronary artery aneurysm and stenosis in a patient with Behçet's disease presenting with non-ST segment elevation myocardial infarction

Coronary artery aneurysms in patients with Behçet's disease are rare and associated with fatal complications. Covered stents have been used in the management of coronary aneurysms but not in patients with Behçet's disease. We are reporting a rare case of Behçet's disease, admitted with non-ST segment elevation myocardial infarction, whose coronary angiogram revealed huge aneurysm involving proximal left anterior descending artery followed by severe stenosis. The stenosis was treated by drug-eluting stent and the aneurysm was successfully sealed with a covered stent. He remained asymptomatic at 3-month follow-up and repeat angiogram showed patent stents. <Learning objective: There is no consensus upon the management of coronary artery aneurysm in a patient with Behçet's disease presenting with acute myocardial infarction. Sealing of aneurysm with covered stent and managing stenosis with drug-eluting stent can also be used for management in these patients with adequate use of immunosuppressant and anticoagulant.>.

Progression of coronary disease in a Behcet's patient in remission

Behcet's disease is characterised histologically by vasculitis. In the heart this can lead to aneurysm formation and thrombosis. There is also accelerated atherosclerosis, the mechanism of which is unclear. Patients with external disease from Behcet's disease are treated with immunosuppression. The authors present a case of aneurysmal disease in a Behcet's patient. This case demonstrates that coronary disease may progress in Behcet's patients despite external disease remission. Therefore, internal disease may progress in the absence of external symptoms when immunosuppressive therapy is usually stopped. This case raises the issue of whether immunosuppression should be continued in Behcet's patients with coronary disease to suppress disease progression or included in a treatment protocol for patients with Behcet's related coronary disease. Clinical trials on the use of immunosuppressive therapy for coronary disease in Behcet's patients are needed.