Clinical Characteristics of Patients with Cardiac Involvement in Behcet's Disease

BACKGROUND AND OBJECTIVES: Despite the sporadic case reports on the cardiac involvement of Behcet's disease, any systemic investigation has not been reported on. We sought to investigate the frequency and clinical characteristics of the patients with the cardiac manifestations of Behcet's disease. SUBJECTS AND METHODS: We retrospectively analyzed the clinical data of 217 patients (mean age: 39+/-11 years) with Behcet's disease who were diagnosed in Asan Medical Center from January 1990 to September 2000. The patients were subgrouped into the mucocutaneous, cardiac, vascular, central nervous system, gastrointestinal and ocular group according to the involved organ. RESULTS: Among 217 patients, nineteen (8.8%) were found to have cardiac involvement: aortic regurgitation was found in ten patients (53%), right ventricular thrombi in six (32%), acute myocardial infarction in two (11%), and myocarditis in one (5%). The incidence of initial oro-genital ulcers at the first clinical presentation was significantly lower in the cardiac Behcet's group than in the other subgroups (52% vs 90%, p=0.001). The event-free survival rate during a mean follow-up duration of 67+/-46 months was also significantly lower in the cardiac Behcet's group (63% vs 14%, p=0.0001). CONCLUSION: Aortic regurgitation and right ventricular thrombus are two common types of cardiac Behcet's disease. Although its incidence is low, cardiac Bechcet's disease has a characteristic pattern for the clinical presentation, and it has a worse prognosis compared with the other subgroups of Behcet's disease that have other solid organ involvement.

Routine Off-pump Total Arterial Coronary Revascularization / 대한흉부외과학회지

BACKGROUND: To avoid the adverse effects of cardiopulmonary bypass and to overcome late vein graft failure, we routinely performed off-pump total arterial coronary revascularization. MATERIAL AND METHOD: From July 2000 to August 2001, 104 consecutive patients underwent first elective off-pump total arterial coronary revascularization. Both internal mammary, radial and gastroepiploic arteries were used. Sequential and composite grafts were used to achieve complete revascularization. Perioperative adverse events and postoperative angiograms were analyzed. RESULT: A total of 252 arterial conduits were used with an average of 2.47 grafts per patient. A total of 326 distal anastomosis were performed with a mean of 3.13 distal anastomosis per patient. Cross over to on-pump occurred in seven patients (6.7%). Of these 4 were due to unstable hemodynamics during lateral or posterior wall stabilization as a result of cardiomegaly and 3 were due to uncontrolled bleeding during dissection of diffusely dimunitive deeply placed intramyocardial coronary arteries. There were no opeartive deaths. Two cases of perioperative myocardial infarction and transient neurologic complications occurred, respectively. Of the 312 distal anastomoses, 308 (98.7%) were compatible with Fitz-Gibbon A or B patency grading. CONCLUSION: Off-pump total arterial coronary revascularization was technically feasible in most elective cases with satisfactory early results. However, on-pump coronary bypass surgery should be considered in difficult circumstances, such as cardiomegaly or unfavorable anatomy of the target coronary artery.

Recurrent Cardiac Tamponade Complicated by Coronary Intervention

Coronary perforation is a rare, but potentially catastrophic complication of percutaneous coronary intervention. It rarely results in cardiac tamponade with the use of standard anticoagulant regimens. But spontaneous cardiac tamponade was reported recently during balloon angioplasty under the large dose of heparin infusion, and after stent implantation under powerful antiplatelet therapy including platelet IIb/IIIa receptor inhibitor administration. We report a case of delayed cardiac tamponade complicated by guidewire manipulation under powerful anticoagulant and antiplatelet therapy, which recurred early after the first pericardiocentesis.