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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 5, September/October 2014
e14
AFRICA
discharged without problems on the 10th postoperative day, with
oral prednisolone, colchicine, azathioprine, a beta-blocker and
aspirin. The one-year follow up was uneventful.
Discussion
Most clinical findings in Behçet’s disease are related to vasculitis,
and arterial disease is commonly seen as small-vessel involvement.
Acute myocardial infarction caused by coronary artery vasculitis
may be seen but this is extremely rare. However, Behçet’s
disease is known to accelerate atherosclerosis, as with another
autoimmune disease, systemic lupus erithematosus.
Aneurysm formation is the most common manifestation
in the arterial system but stenosis or occlusion may be seen in
the coronary vessels, caused by fibrous intimal thickening and
localised vasculitis. Coronary arterial disease is generally treated
with either conservative or invasive procedures. CABG is very
rarely performed.
Some surgeons prefer not to perform CABG because the
tissues are fragile, the grafts are affected by inflammation, and
hypercoagulopathy may be a problem peri-operatively.
5
Others
recommend percutaneous interventions (PCI) or minimally
invasive procedures such as off-pump techniques.
6
In our
patient, LIMA-to-LAD anastomosis and two saphenous grafts
for the diagonal and right coronary arteries were used with
cardiopulmonary bypass procedure. Coronary arterial disease in
this patient was adversely affecting the quality of his life and the
lesions were not amenable to PCI or stent use.
Major problems after surgery are bleeding and anastomotic
pseudo-aneurysm. Minimal manipulation of the tissues, taking
care of bleeding peri-operatively and the use of corticosteroids
are important for these severe complications. For this reason, we
prefered oral steroids for our patient after surgery.
Another problem in Behçet’s disease is haematoma/
pseudo-aneurysm, including the femoral artery after coronary
angiography. Multiple punctures should be avoided and
catheters should be removed as soon as possible to prevent
these complications. We removed all the catheters on the first
postoperative day.
There is uncertainty about whether the coronary lesions are
caused by atherosclerosis or vasculitis in these patients. Also,
there are no comprehensive studies on the long-term patency of
the grafts used for coronary bypass in Behçet’s disease because
the grafts may be affected by the disease. There is a need for these
kinds of studies involving large numbers of patients.
Conclusion
Behçet’s disease involves all types of vessels but coronary arterial
involvement is extremely rare. The patients are generally young
and they are frequently treated medically. CABG is very rarely
performed on these patients and off-pump techniques are
generally prefered. In our opinion, when CABG is necessary,
minimal manipulation of the tissues, careful choice of
grafts, awareness of thrombosis and other peri/postoperative
complications are very important for these patients.
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