Cardiovascular Journal of Africa: Vol 25 No 5 (September/October 2014)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 5, September/October 2014 AFRICA e13
Case Report
Coronary artery bypass grafting in a Behçet’s disease
patient
Mehmet Tasar, Zeynep Eyileten, Burcu Arici, Adnan Uysalel
Abstract
Behçet’s syndrome is a chronic, multisystemic, inflamma-
tory, vasculitic disorder characterised by oral aphta, ocular
lesions, genital ulcers and the involvement of other systems.
Although vascular involvement is seen frequently, coronary
artery disease is extremely rare in Behçet’s disease and it is
generally treated with invasive or conservative procedures. In
this case, we aimed to present a successful bypass grafting of
three vessels using cardiopulmonary bypass in a patient with
Behçet’s disease.
Keywords: Behçet’s disease, coronary artery bypass surgery,
vasculitis
Submitted 2/4/14, accepted 18/8/14
Cardiovasc J Afr 2014; 25: e13–e14
DOI: 10.5830/CVJA-2014-052
Behçet’s disease was first defined in 1937 by Hulusi Behçet
who was a Turkish dermatologist. It is classified in vasculitic
disorders as an autoimmune disease. This disease affects multiple
systems including the eye, musculoskeletal, skin, neurological
and cardiovascular, with a variety of clinical presentations.
Vascular involvement is seen frequently (7–29%) and it is usually
related to the venous system. Cardiac involvement is extremely
rare (0.2%).1
Arterial system involvement is rarely seen compared to
the venous system. Thrombus formation, pseudo-aneurysm,
stenosis and occlusion can be seen in the arterial structures and
these may be fatal. In Behçet’s disease, endothelial function is
affected to varying degrees, and additionally, patients are prone
to hypercoagulation, caused by activated endothelial cells and
platelets.
Little is known about the origin of the inflammatory
obliterative endarteritis, endothelial cell activation and
perivascular mononuclear cell infiltration, which cause damage
to the vascular media and deterioration in the arterial and
venous structures. Aneurysm formation is frequently seen,
however, stenosis and oclusions caused by endothelial damage
and hypercoagulation are rarely seen.2
Involvement of the coronary arterial system is extremely
rare in Behçet’s disease and these patients are generally
treated conservatively. The number of patients undergoing
coronary artery bypass grafting (CABG) is low because these
tissues become fragile, vascular structures are destroyed and
hypercoagulation is frequent in these patients.3,4 The grafts that
are used for CABG surgery may be affected by the disease and
this is related to long-term failure.
Behçet’s disease is a chronic autoimmune vasculitis and
patients are commonly on immunsupresive therapy before
surgery. This is also a risk for surgery and postoperative survival.
For these reasons, the decision to operate is controversial.
Surgeons generally avoid surgical manipulation as much
as possible. When CABG is inevitable, minimally invasive
procedures would be prefered. If cardiopulmonary bypass is
absolutely necessary, the surgeon must be mindful of these risks.
Case report
A 53-year-old man, whose Behçet’s disease was diagnosed 30
years earlier, had been on colchicine therapy since then. He had
had deep venous thrombosis in his left leg three years previously,
and had been using azathioprine for three years.
He complained of a burning in the midline of his chest for the
last year and had no cardiac risk factors (e.g. smoking, diabetes
mellitus, dyslipidaemia, hypertension) except Behçet’s vasculitis.
There was no pathology on colour Doppler ultrasonography,
and pulmonary computed tomography was normal. Coronary
angiography was performed and the decision was made to
perform CABG because he had significant stenosis in the
proximal left anterior descending (LAD), diagonal and right
coronary arteries.
The left internally mammary artery (LIMA) was anastomosed
to the LAD using cardiopulmonary bypass (CPB). Diagonal and
right coronary anastomoses were performed using saphenous
vein grafts. All tissues were very fragile so we had to be careful
with manipulation and the control of bleeding.
The surgery was non-problematic. On the first day after the
operation, 850 cm3 blood from the chest tubes was detected and
followed up. There were no other complications. We did not use
an anticoagulant, only antiplatelet therapy (300 mg/day aspirin).
The chest tubes were removed on the fifth day. The patient was
Deprtment of Cardiovascular Surgery, Ankara University
School of Medicine, Ankara, Turkey
Mehmet Tasar, MD,
Zeynep Eyileten, MD
Burcu Arici, MD
Adnan Uysalel, MD