Coronary artery disease and coronary artery bypass grafting in Behçet's disease

There is a high frequency of pseudoaneurysm formation in patients with Behçet's disease and their inflammed and fragile tissues are difficult to manipulate. Five patients with Behçet's disease were referred to our cardiovascular surgery department for coronary artery bypass grafting (CABG). Three of them were operated and two were treated medically. Patients that were managed medically had left anterior descending (LAD) lesions below 80% and their stable angina pectoris responded well to medication. There was no early mortality and morbidity. One patient developed pseudoaneurysm of ascending aorta and femoral artery. This patient died in the late postoperative period. At follow-up the operated patients were in Canadian Cardiovascular Society (CCS) Class I, while the medically treated patients were in CCS Class II. Mean follow-up period was 41 +/- 36.21 months. Coronary artery disease (CAD) is extremely rare detected in patients with Behçet's disease. The affected patients are usually young males. Coronary artery bypass grafting is also rarely performed in these patients and long-term results of such operations are not available in the literature. We present five patients with Behçet's disease that had CAD, three operated and two medically treated, and report their long-term results. We suggest a conservative approach in patients with Behçet's disease because of the high risk of pseudoaneurysm formation in the postoperative period. If CABG cannot be avoided we recommend operating the patients on the beating heart with minimal aortic manipulation.