Valvular surgery in Behcet's disease
Vedat Erentug1, Adil Polat, Nilgun Ulusoy Bozbuga
1Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
Insights
Behcet's disease patients undergoing valve replacement require strict anticoagulation due to hypercoagulability. Bileaflet mechanical valves are recommended for these patients to minimize risks.
Area of Science:
- Cardiovascular Surgery
- Rheumatology
- Hematology
Background:
- Behcet's disease is a chronic inflammatory condition associated with a hypercoagulable state.
- Intracardiac masses in Behcet's disease patients may indicate thrombus formation.
- Valvular disease necessitates surgical intervention in some Behcet's disease patients.
Purpose of the Study:
- To analyze outcomes of Behcet's disease patients who underwent surgical valve replacement.
- To evaluate the safety and efficacy of mechanical bileaflet prostheses in this patient population.
- To emphasize the importance of managing hypercoagulability during cardiac surgery.
Main Methods:
- Retrospective analysis of three Behcet's disease patients (1 male, 2 female) who underwent valve replacement.
- Aortic valve replacement in two patients and mitral valve replacement in one patient using mechanical bileaflet valves.
- Continued steroid therapy postoperatively and strict anticoagulation with warfarin (target INR 3-3.5).
Main Results:
- No early or late mortality observed.
- Uneventful intraoperative and postoperative courses for all patients.
- One late cerebrovascular accident occurred 40 months post-mitral valve replacement, despite a functional prosthesis.
Conclusions:
- Hypercoagulability in Behcet's disease necessitates stringent anticoagulation protocols.
- Mechanical bileaflet prostheses are recommended for valve replacement in Behcet's disease patients.
- Careful patient selection and management are crucial for successful outcomes.
Background:
Behcet's disease is a chronic inflammatory disease with a relapsing course. Behcet's disease affects many systems and causes hypercoagulability, and detection of an intracardiac mass in a Behcet patient should raise the question of an intracardiac thrombus. We analyzed our patients with Behcet's disease operated for valvular disease.
Methods:
We operated three patients (one male and two females) who had been diagnosed as having Behcet's disease previously. Using mechanical bileaflet valves, aortic valve replacement in two and mitral valve replacement in the other patient were performed. Mechanical valve replacement was performed using pledgetted-interrupted sutures in the mitral procedure. Patients' steroid therapies were not interrupted and in the postoperative course, steroid was continued. No reoperations were needed. Anticoagulation with warfarin was instituted after the operation with the target of an international normalized ratio (INR) between 3 and 3.5.
Results:
There was no mortality either early or late follow-up. Intraoperative and postoperative courses were uneventful. Two had ventricular arrhythmias. Total follow-up was 23.3 patient/years with a mean of 93.3 +/- 64.7 months. In the late follow-up, patient with the mechanical mitral valve experienced a cerebrovascular accident 40 months after the operation. Her echocardiographic examination gave a functional valve without any pathology.
Conclusions:
Surgeons should remember the hypercoagulable state in Behcet patients and strict anticoagulation protocols should be utilized. In the operations, bileaflet prostheses should be used.
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