ABSTRACT
A 32-year-old pregnant woman, diagnosed with Behçet's disease 6 months earlier, presented with recent mild hemoptysis and exertional dyspnea. Transthoracic echocardiography showed an enlarged dysfunctional right ventricle. A large hypoechoic triangular-shaped mass was seen attached to the inner right ventricular wall, filling the cavity. No change in the size of the mass was noted after anticoagulant administration, and right heart failure progressed. Surgery was performed to remove the mass and repair the tricuspid valve. This was a very rare presentation of Behçet's disease in pregnancy, which resulted in delivery of a completely healthy baby despite corticosteroid pulse therapy and cyclophosphamide.
Subject(s)
Behcet Syndrome/complications , Endomyocardial Fibrosis/etiology , Myocardium/pathology , Pregnancy Complications, Cardiovascular/etiology , Adrenal Cortex Hormones/therapeutic use , Adult , Behcet Syndrome/diagnosis , Behcet Syndrome/drug therapy , Biopsy , Cardiac Surgical Procedures , Echocardiography , Endomyocardial Fibrosis/diagnostic imaging , Endomyocardial Fibrosis/pathology , Endomyocardial Fibrosis/surgery , Female , Fibrosis , Heart Failure/etiology , Heart Failure/physiopathology , Humans , Hypertrophy, Right Ventricular/etiology , Hypertrophy, Right Ventricular/physiopathology , Immunosuppressive Agents/therapeutic use , Live Birth , Pregnancy , Pregnancy Complications, Cardiovascular/diagnostic imaging , Pregnancy Complications, Cardiovascular/pathology , Pregnancy Complications, Cardiovascular/surgery , Treatment Outcome , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/physiopathology , Ventricular Function, Right , Ventricular RemodelingABSTRACT
INTRODUCTION: Studies often suggest hypoxemia is an important factor for sodium retention in chronic obstructive pulmonary disease (COPD), although hypercapnia is also associated with sodium retention in these patients. Hence, we have presented the major role of PaCO(2) in edema due to COPD. METHOD: COPD patients who were hospitalized due to exacerbation were enrolled in the study and divided into two groups: with and without edema. Exclusion criteria included primary hepatic diseases, nephrotic syndrome and other renal diseases, left heart failure, or using drugs that would interfere with these organs or endocrine function. Data were coded and analyzed by SPSS software. Arterial blood gas variables including bicarbonate, pH, and PaO(2), PaCO(2) and O(2) saturation, and FEV1, FVC, FEV1/FVC were measured and compared between the groups. RESULTS: No significant difference was found between the averages of bicarbonate, pH, PaO(2), 02 saturation, FEV1, FVC and FEV1/FVC in COPD in the two groups. PaCO(2) levels were significantly higher in patients with edema, compared to those without edema (p = 0.05). A reverse and significant correlation between PaCo(2) and FEV1 levels (p = 0.03) (r = -0.501) was observed in patients with edema. CONCLUSION: This study suggests that hypercapnia is a major factor in causing edema in COPD patients compared to hypoxemia.
