HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Makoto Ando Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ando, M. Search for Related Content PubMed PubMed Citation Articles by Ando, M. Related Collections Valve disease Related Article

---

Original Articles: Adult Cardiac

Invited Commentary

Department of Pediatric Cardiac Surgery, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003 Japan

(Email: maando{at}shi.heart.or.jp).

This article by Jeong and colleagues [1] is a report on the results of aortic valve surgery in patients with Behçet disease. Because its incidence is low and the prevalence is geographically concentrated in Asia, information on this group of patients is limited. This landmark article presents 19 cases undergoing aortic valve procedure for a total of 46 times during a 20-year period, and it is one of the largest cohorts and longest follow-ups of all.

Behçet disease is generally not life-threatening if managed appropriately; however it can be fatal if a cardiovascular lesion is involved. Aortic valve disease is especially challenging due to the notoriously fragile tissue, which is prone to cause dehiscence and pseudoaneurysm. The article [1] clearly demonstrated that the first-time aortic valve operation can be performed with a low mortality rate, but reoperation still carries a high risk. Therefore, maximum effort should be made to avoid repeat operations. As the article confirms, the most promising maneuver is an aortic root replacement using a homograft, with concomitant annular reinforcement whenever necessary. As for postoperative management, strict immunotherapy with monitoring of inflammatory markers is recommended.

However, there are several important issues that are not discussed. First is the choice of prosthesis when a homograft is not available. The type with a soft sewing ring such as a stentless bioprosthesis may be an option, but this is still controversial. Second, is regarding the optimal pharmacological therapy. Given the seriousness of recurrence, it may be legitimate to increase steroids and other anti-inflammatory drugs beyond the regular doses, and combine immunosuppressive (including new-line) drugs. Finally, the management of coronary stenosis is to be considered. This is believed to occur due to suture line stenosis or coexisting coronary vasculitis and warrants maximum attention. In-depth discussions of these unresolved issues may further improve surgical results.

	References

Top References

 

1. Jeong DS, Kim K-H, Kim JS, Ahn H. Long-term experience of surgical treatment for aortic regurgitation attributable to Behçet's disease Ann Thorac Surg 2009;87:1775-1782.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Makoto Ando Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ando, M. Search for Related Content PubMed PubMed Citation Articles by Ando, M. Related Collections Valve disease Related Article