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Cardiac valve replacement in relapsing polychondritis. A review
L Lang-Lazdunski1, U Hvass, C Paillole
1Department of Thoracic and Cardiovascular Surgery Hospital, Bichat, Paris, France.
The Journal of Heart Valve Disease
|May 1, 1995
Summary
Cardiac valve replacement is necessary for some relapsing polychondritis patients, but carries high risks. Early reoperation and death from cardiovascular causes are common, necessitating close monitoring and potentially prophylactic aortic repair.
Area of Science:
- Cardiology
- Rheumatology
- Immunology
Background:
- Relapsing polychondritis (RP) can affect cardiac valves, leading to rare but significant valve replacement needs.
- Patients with RP undergoing cardiac valve replacement face unique postoperative challenges.
Purpose of the Study:
- To analyze outcomes of cardiac valve replacement in patients with relapsing polychondritis.
- To highlight the risks and recommend management strategies for cardiovascular involvement in RP.
Main Methods:
- Case report of one patient undergoing aortic and mitral valve replacement.
- Literature review of 20 additional patients with RP requiring cardiac valve replacement.
Main Results:
- The mean age at operation was 38.8 years, with a male preponderance (73.7%).
- High rates of reoperation (23.8%) for periprosthetic leak or aortic aneurysm and cardiovascular death (52.6%) within four years post-surgery.
- Aortic and mitral valves were most commonly replaced.
Conclusions:
- Patients with RP and cardiovascular involvement require immunosuppressive agents, potentially more effective than steroids.
- Close, prolonged follow-up is crucial due to risks of prosthetic leakage, aortic aneurysms, and other organ involvement.
- Prophylactic aortic repair alongside valve replacement may reduce reoperation rates in high-risk patients.