| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
a Department of Cardiac Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, Bologna, 40138 Italy
b Department of Pathology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, 40138 Italy
c Department of Cardiac Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, 40138 Italy
(Email: dpacini{at}hotmail.com).
We appreciate Dr Akgul's kind comments [1] on our article [2] and recognize his personal insight and institutional experience regarding "vasculo-Behçet" disease.
In our article, we reported our overall experience with thoracic inflammatory aortopathies; unfortunately, we have had very limited experience with Behçet disease (only 1 patient). We totally agree with Dr Akgul that in these patients, even the cannulation site could be a serious problem. In fact, our patient had to be reoperated on several times: first, due to the detachment of the conduit from the aortic annulus; then, for the complete detachment of the coronary ostia from a valved graft; and, lastly, due to the development of a pseudoaneurysm of the right femoral artery at the cannulation site 7 years after the operation. Nevertheless, we think that surgical repair is indicated in the presence of an aortic aneurysm because of the high incidence of rupture or dissection and should be performed regardless of long-term complications [3, 4]. In case of rupture, impending rupture, or dissection, an aggressive approach can be life-saving; however, if possible, surgical intervention should be postponed until the active inflammation phase has subsided.
With regard to the low incidence of developing new aneurysms during follow-up, this was probably because giant cell arteritis was the main histopathologic finding in our cohort of patients (30 of 39), and this pathology may not involve the arterial vessels as diffusely. However, no anti-inflammatory therapy was started in patients in whom a diagnosis of inflammatory disease was made postoperatively. Patients with a preoperative diagnosis of connective tissue disorder (Behçet disease and systemic lupus erythematosus) or Takayasu arteritis continued their immunosuppressive and anti-inflammatory therapy.
We can speculate that the higher mortality of this cohort of patients might be related to the nature of the pathology and to the quality of the aortic wall, but we cannot draw definitive conclusions because this was not a risk-adjusted population.
With regard to the preoperative measurement of C-reactive protein and erythrocyte sedimentation rate, we proposed its routine use in all patients who undergo aortic operations because preoperatively diagnosing inflammatory aneurysms is frequently very difficult as there are no suggestive signs of inflammatory disease on the preoperative radiologic studies. On the other hand, in the case of systemic inflammatory disease, as in the case of Behçet disease, the inflammatory etiology can easily be hypothesized, and C-reactive protein or erythrocyte sedimentation rate measurements are not necessary for making the diagnosis. In these cases, as pointed out by Dr Akgul, other laboratory tests should be performed to define the phase of the disease, especially in patients with Behçet disease.
 |
References |
|---|
 Top References |
|---|
Related Article
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
