Abstract
Standard aortic valve replacement for aortic regurgitation caused by Behçet disease
(BD) is frequently complicated by postoperative recurrent prosthetic valve detachment.
Tumour necrosis factor (TNF) α is known to be associated with higher inflammation
activities. Therefore, the concomitant use of immunomodulatory agents with TNFα inhibitors
may be the key to a better outcome. This is a case report of a 46-year-old woman with
severe acute aortic regurgitation due to BD. Immunosuppressive therapy including the
TNFα inhibitor infliximab, which has not been reported for perioperative use to date,
resulted in the prompt remission of inflammation, leading to the success of Bentall
surgery.
Résumé
Après une chirurgie de remplacement valvulaire aortique standard pour corriger un
problème de régurgitation aortique causé par la maladie de Behçet, il arrive souvent
que la prothèse valvulaire se détache à répétition. On sait par ailleurs que le facteur
de nécrose tumorale alpha (TNFα) est associé à une augmentation de l’activité inflammatoire.
Par conséquent, l’emploi d’un agent immunomodulateur et d’un inhibiteur du TNFα en
concomitance pourrait donc être la clé d’une issue plus favorable. Nous exposons le
cas d’une femme de 46 ans présentant une grave régurgitation aortique aiguë causée
par la maladie de Behçet. L’instauration d’un traitement associant un immunosuppresseur
et un inhibiteur du TNFα (l’infliximab), une stratégie dont la mise en œuvre dans
un contexte périopératoire n’a jamais été rapportée à ce jour, a entraîné une résorption
rapide de l’inflammation, ce qui a permis de réaliser une intervention de Bentall
réussie.
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References
- Aortic regurgitation caused by Behçet’s disease: surgical experience during an 11-year period.J Card Surg. 2012; 27: 39-44
- Aortic valve replacement in Behçet’s disease: surgical modification to prevent valve detachment.Eur J Cardiothorac Surg. 2009; 36: 771-772
- Long-term outcome of arterial lesions in Behçet’s disease: a series of 101 patients.Medicine (Baltimore). 2012; 91: 18-24
- Behçet’s disease: successful treatment with infliximab in 7 patients with severe vascular manifestations. A retrospective analysis.Arthritis Care Res (Hoboken). 2012; 64: 607-611
- Perioperative anti–tumor necrosis factor therapy does not increase the rate of early postoperative complication in Crohn’s disease.J Gastrointest Surg. 2010; 14: 1859-1866
Article info
Publication history
Published online: March 29, 2020
Accepted:
March 18,
2020
Received:
November 5,
2019
Footnotes
See page 1161.e5 for disclosure information.
Identification
Copyright
© 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
