Valvular surgery in Behcet's disease.
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.
Erentug
Vedat
V
Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
Polat
Adil
A
Bozbuga
Nilgun Ulusoy
NU
Erdogan
Hasan Basri
HB
Ozkaynak
Berk
B
Akinci
Esat
E
Yakut
Cevat
C