CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 2, March/April 2014
AFRICA
63
Behcet’s disease and cardiovascular involvement:
our experience of asymptomatic Behcet’s patients
Zeynep Ulusan, Ayse Serap Karadag, Mehmet Tasar, Mehmet Kalender, Osman Tansel Darcin
Abstract
Behcet’s syndrome is a systemic inflammatory disease
associated with vasculitis, and arterial, venous and cardiac
disorders. Thirty-eight Behcet’s disease patients were exam-
ined prospectively with echocardiography, ultrasonography
and computed tomography, and coagulation parameters were
determined. Deep venous insufficiency was found in 16
patients, venous thrombosis in seven, one patient had iliac
artery stenosis, three had carotid arterial intimal proliferation,
two patients had aortic annulus dilatation, six had aortic valve
insufficiency, and three had mitral valve insufficiency. None
had coagulation defects. To decrease morbidity and mortal-
ity rates, a multidisciplinary approach is important for early
diagnosis of cardiovascular involvement in Behcet’s disease.
Keywords:
Behcet’s disease, venous thrombosis, valvular heart
disease
Submitted 23/7/13, accepted 4/2/14
Cardiovasc J Afr
2014;
25
: 63–66
DOI: 10.5830/CVJA-2014-003
Behcet’s disease is generally defined by oral and genital ulcers
and uveitis. It is also known as a recurrent multisystemic and
inflammatory disease. It is mostly seen in Mediterranean
countries and the Far East.
The aetiology of Behcet’s disease is associated with viral,
toxic, bacterial and immunological factors. It was defined in
1963 as an auto-immune disease caused by auto-antibodies
against the oral mucosa. Vascular involvement is 2–7% and it
is usually seen in patients between the ages of 20 and 40 years.
Behcet’s disease is a non-specific arterial and venous
vasculitis.
1-8
Proximal and distal anastomotic aneurysm formation
after surgery is not rare one to 12 months postoperatively.
Recurrent surgical interventions increase the risk of mortality
and morbidity.
9,10
Cardiovascular involvement in Behcet’s disease
includes pericarditis, coronary arterial disease, cardiomyopathy
and valvular dysfunction.
11
The aim of this study was to report
our experience of cardiovascular involvement with asymptomatic
Behcet’s disease.
Methods
From March 2008 to May 2009, 38 Behcet’s disease patients (20
women and 18 men) were prospectively analysed at the Kecioren
Education and Research Hospital. International Behcet’s disease
study group criteria were used for the diagnosis of Behcet’s
disease in all patients.
12
Follow up of the patients was one to
20 years (mean 10.5 years). Mean age was 37.8 years (range
33.8–41.7).
After questioning the patients on their medical history and
detailed physical examination, radiological and laboratory studies
were undertaken. Patients who had formerly been diagnosed with
Behcet’s disease and followed up were included in the study,
whereas those who were newly diagnosed were not included.
There was no history of smoking, hypertension, diabetes
mellitus, rheumatic carditis or valve disease in the patients’
backgrounds. In some patients, no cardiac risk factors were
detected except high levels of low-density lipoprotein cholesterol
(LDL-C). No ventricular contractility disorder was detected on
transthoracic electrocardiographic examinations.
Echocardiographic diameters were measured as transthoracic
and two-dimensional by Prob, which can screen between 2 and 4
or 1.5 and 4.5 MHz. Volumes were measured with two and four
blank images by the modified Simpson’s method. Each valve
structure and its function was evaluated by Vivid 3 pro series Ge
Vivid 3 echocardiography (GE Medical Systems, Milwaukee,
USA).
Doppler ultrasonography was performed in B-mode and
colour-mode spectral examinations with 13.5- and 9.4-MHz
linear probes (Antares, SiemensAG, Medical Solutions Henkestr,
Erlangen, Germany). Upper and lower extremity arterial and
venous (for venous insufficiency, thrombosis, arterial stenosis
and aneurysm) and carotid examinations were carried out.
Thorax and abdominal computarised tomography was
performed in 5-mm sections, initially unenhanced, three to
five minutes after venecontrast substance was injected into the
peripheral veins, to determine abdominal and thoracic vascular
structures (Simens Somatom Sensation 16 software version A50
Germany).
Blood samples were taken between 9:00 and 10:00 after an
overnight fast and no viral, infectious or immunological diseases
were detected. Laboratory studies were carried out on venous
blood (9 units), which was centrifuged for 15 minutes at 20ºC and
4 500 rpm. It was decanted into silicone tubes (Vacutainer, Becton
Dickinson, New Jersey, ABD) containing 0.105 M trisodium
citrate (1 unit). Total cholesterol and triglyceride levels were
detected by enzymatic methods (Roche Diagnostics, Mannheim,
Kecioren Research and Training Hospital, Ankara, Turkey
Zeynep Ulusan, MD,
Department of Dermatology, 100.yil University Medical
School, Van, Turkey
Ayse Serap Karadag, MD
Department of Surgery, Konya Education and Research
Hospital, Konya, Turkey
Mehmet Tasar, MD
Mehmet Kalender, MD
Osman Tansel Darcin, MD
