Coronary Involvement in Behçet's Disease: what are its Risks and Prognosis? (Rare Cases and Literature Review)

Abstract

Objective In our clinic, we aimed to investigate the effect of preoperative risk factors and postoperative complications on reoperation and mortality in cases with Behçet's disease which presents very rare coronary artery involvement.Methods Thirteen patients with Behçet's Disease who had undergone coronary artery bypass grafting in our center between 2003 and 2015 were analyzed. We evaluated the clinical and laboratory findings, complications and mortality rates of our patients in light of the literature.Results The mean age was 38.5 (30-55; 3 women). The mean time from onset of Behçet's disease to coronary artery disease was 4,7 (3-11) years. Fifty-four percent of the patients were asymptomatic. Coronary artery disease of these was exposed while peripheral vascular surgery was planned due to complications of Behçet's disease. Symptomatic patients presented angina pectoris (31%), acute coronary syndrome (8%) and arrhythmia (8%). In coronary pathology of patients, distal type obstruction (31%), aneurysm and pseudoaneurysm (31%), proximal segment thrombus (15%), chronic type stenosis and occlusions (31%) were present. Early mortality (15%) was due to acute myocardial infarction while the late mortality (15%) was due to cerebral and gastrointestinal bleeding. Reoperation was due to bleeding in one case on the 1st postoperative day and due to acute pulmonary embolism in another case in the 3rdpostoperative year.Conclusion In Behçet's disease, coronary artery bypass grafting is a procedure with high mortality, especially in the acute period. The on-pump surgery technique in these cases can be safely performed for multiple bypasses and in patients above 40 years old.

Uveitis as a potential predictor of acute myocardial infarction in patients with Behcet’s disease: a population-based cohort study

“…The high prevalences of peripheral venous thrombosis (20%) and arterial thrombosis (10%) presented in table 1 were compatible with Vural’s study in Turkey. 20 Furthermore, our study revealed a higher prevalence of coronary artery thrombosis in AMI among the uveitis group than in the non-uveitis group, implying tendency to thrombosis could also be related to the occurrence of AMI, especially in the uveitis group.…”

Acute myocardial infarction as the initial presentation of behcet's syndrome

“…Vascular involvement is seen in 7%–38% of cases with a high mortality in severe affliction. [ 4 5 ] Interestingly, there is a greater predilection of the venous system compared to arterial involvement. Cardiac involvement can be life-threatening and has been reported variably anywhere between 1% and 16%.…”

Cardiac complication spectrum of Behçet disease in Tunisia: A 10-case series: Clinical and therapeutic approach

“…This happens along with a disequilibrium of scavenging enzymes which eventually leads to destructive effects [15]. Indeed, vasorum occlusion and transmural necrosis in the walls of the large muscular arteries ensues leading to deterioration of blood flow and then degeneration of vessel wall [28,29].…”

“…Thromboembolism mainly triggered by endothelial dysfunction is also a characteristic finding in BD, so endothelium-dependent flow-mediated dilation is diminished causing therefore an increase in vascular inflammation. Furthermore, the associated thrombin and fibrin release and decreased fibrinolysis [28,30] will eventually lead to heart and vessel lesions [31,32].…”

“…However, if conventional angiography is chosen it is important to be careful with its complications like pseudoaneurysmal formation and infectious risk with femoral puncture. As a result, non-invasive methods such as ultrasonography, magnetic resonance and computerized tomography angiography should be preferred primarily for diagnosis [28].…”