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Aortic valve involvement in Behçet's disease. A clinical study of 9 patients
Choong Won Lee1, Jisoo Lee, Won Ki Lee
1Division of Rheumatology, Department of Internal Medicine, Wallace Memorial Baptist Hospital, Gumjung-Gu P.O. Box 100 Namsan-Dong Gumjung-Gu, Busan, Korea, 609-340.
Insights
Prosthetic aortic valve replacement in Behçet's disease (BD) patients has high complication rates, including detachment and death. Postoperative immunosuppressive therapy significantly improved outcomes, highlighting its importance.
Area of Science:
- Cardiology
- Rheumatology
- Immunology
Background:
- Behçet's disease (BD) is a multisystem inflammatory disorder.
- Aortic valve involvement in BD presents unique surgical challenges.
Purpose of the Study:
- To evaluate clinical features, pathology, and outcomes of aortic valve replacement in BD patients.
- To assess the impact of immunosuppressive therapy on postoperative results.
Main Methods:
- Retrospective review of 9 BD patients undergoing 17 aortic valve replacement procedures.
- Analysis of postoperative complications, prosthetic valve detachment, and mortality.
- Comparison of outcomes with and without postoperative immunosuppressive therapy.
Main Results:
- Diffuse myxoid degeneration was common in affected aortic valves.
- High rates of prosthetic valve detachment (76%) and complications (82%) occurred post-surgery.
- Mortality was 44%, often due to heart failure or infection.
- Mechanical valves had higher rates of dehiscence (92%) than tissue valves (40%).
- No complications occurred in 2 patients receiving postoperative immunosuppressive therapy, versus 87% in those not treated.
Conclusions:
- Prosthetic valve detachment is more frequent in BD patients with aortic valve involvement.
- Aortic valve disease is a poor prognostic indicator in BD.
- Intensive postoperative immunosuppressive therapy and optimized surgical techniques are crucial for improving outcomes.
Objectives:
To assess the clinical features, pathologic findings, postoperative results and the effects of immunosuppressive therapy in patients with Behçet's disease (BD).
Methods:
We reviewed the postoperative course of the 9 BD patients who underwent a total of 17 aortic valve replacement procedures with prosthetic valves.
Results:
Histological examination of the aortic valve commonly revealed diffuse myxoid degeneration (75 percent). Of 17 valve replacement surgeries, 13 surgeries resulted in complications, such as detachment of the prosthetic valve with perivalvular leakage and dehiscence of the sternotomy wound, within an average of 5 months (range from 1 month to 14 months). The rate of prosthetic valve detachment was 76 percent (13 of 17 surgeries). Four of the 9 patients (44 percent) who underwent aortic valve replacement procedures died of heart failure or infection associated with the detachment of the prosthetic valve, and perivalvular leakage within an average of 9 months. Aortic insufficiency associated with dehiscence of the prosthetic valve developed in 11 of 12 surgical cases (92 percent) with a mechanical valve and 2 of 5 surgical cases (40 percent) with tissue valves. Thirteen of 15 surgeries (87 percent) which were not given postoperative immunosuppressive therapy developed complications, while none of 2 surgeries that used postoperative immunosuppressive therapy with prednisolone (1 mg/kg/day) and azathioprine (100 mg/day) had these complications.
Conclusion:
The rates of prosthetic valve detachment in BD involving aortic valve were higher than those of other diseases. Aortic valve involvement was also one of the poor prognostic factors in BD. Intensive postoperative immunosuppressive therapy and surgical methods may be important factors for postoperative results.