Valvular surgery in Behcet's disease
Valvular surgery in Behcet's disease
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DOI：
10.1111/j.1540-8191.2006.00234.x
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发表时间：
2006-05-01
影响因子：
1.6
通讯作者：
Yakut, C
中科院分区：
文献类型：
--
作者：
Erentug, V;Polat, A;Yakut, C
背景：白塞病是一种复发性慢性炎症性疾病。白塞病影响许多系统并引起高凝状态，白塞病患者心内肿块的检测应引起心内血栓的问题。我们分析了我们的患者白塞病手术的瓣膜疾病。方法：我们手术治疗了三名患者（一男两女）谁曾被诊断为白塞氏病以前。采用机械双叶瓣，其中2例行主动脉瓣置换术，1例行二尖瓣置换术。在二尖瓣手术中使用带垫片间断缝合进行了机械瓣膜置换术。患者的类固醇治疗没有中断，在术后过程中，类固醇继续。无需再次手术。术后采用华法林抗凝，目标国际标准化比值（INR）在3 - 3.5之间。结果：早期和晚期随访均无死亡。术中和术后过程顺利。2例出现室性心律失常。总随访时间为23.3例患者/年，平均93.3 +/- 64.7个月。在后期随访中，机械二尖瓣患者在术后40个月发生脑血管意外。她的超声心动图检查显示瓣膜功能正常，无任何病理。结论：外科医生应记住白塞病患者的高凝状态，应采用严格的抗凝方案。在手术中，应使用双叶假体。
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.