Inhibition of SA Node at Supine Position in Right Atrial Thrombus Complicating Behçet's Disease - From Cardiac Surgical Point of View.
BACKGROUND
Behçet's disease (BD) is a chronic multi-systemic disease of unknown cause. Intra-cardiac thrombus (ICT) complicating BD is extremely rare. In general, cardiac manifestations in BD are associated with poor prognosis. Chest computed tomography (CT) scan and echocardiogram are excellent modalities for diagnosis and patient assessment. Cardiac surgical intervention can be done safely using an on-pump technique when medical management has failed.


METHODS
We report on a case of a 27-year-old Jordanian woman diagnosed with BD who presented with dyspnea, cough, and hemoptysis, with supine bradycardia reaching 36 beats/minute and dizziness which disappear on sitting or standing position, and with heart rate reaching 76 beats/minute. Right atrial thrombus was identified using transthoracic echocardiogram and chest CT scan. After medical management failed, cardiac surgical intervention became an option and targeted extraction of the right atrial thrombus compressing the sinoatrial node (SA node).


CONCLUSIONS
In BD, right atrial thrombus compressing the SA node is rare. If conservative management has failed, cardiac surgical intervention removing the mechanical cause can be done safely, either using on-pump with cross clamp or on-pump with beating heart technique.
Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology, Irbid, Jordan.
Emad Mohamed
EM
Hijazi
Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology, Irbid, Jordan.
Rasheed Khaled
RK
Ibdah
Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology, Irbid, Jordan.
Sukina Ismael
SI
Rawashdeh
Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology,, Irbid, Jordan.
Abdullah Mahmoud
AM
Saadeh
Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology, Irbid, Jordan.
Hamzeh Ibrahim
HI
Al-Balas
D000328:Adult; D001528:Behcet Syndrome / Q000150:complications*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000601:surgery; D006331:Heart Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D012849:Sinoatrial Node / Q000503:physiopathology*; D016683:Supine Position / Q000502:physiology*; D013927:Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery