An Adolescent With Aortic Regurgitation Caused by Behçet's Disease Mimicking Endocarditis Hyun Mi Kang, MD, Gi Beom Kim, MD, Woo-Sung Jang, MD, Bo Sang.

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Presentation transcript:

An Adolescent With Aortic Regurgitation Caused by Behçet's Disease Mimicking Endocarditis Hyun Mi Kang, MD, Gi Beom Kim, MD, Woo-Sung Jang, MD, Bo Sang Kwon, MD, Eun Jung Bae, MD, Chung Il Noh, MD, Jung Yun Choi, MD, Yong Jin Kim, MD The Annals of Thoracic Surgery Volume 95, Issue 6, Pages e147-e149 (June 2013) DOI: 10.1016/j.athoracsur.2012.11.027 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A, solid arrow) Preoperative transesophageal echocardiography. Oscillating redundant tissue with shaggy left coronary cusp surface and prominent marginal thickening on all aortic cusps. (B, dotted arrow) Coaptation failure. (A, arrowhead) Redundant tissue at the mid portion of anterior mitral leaflet. (LA = left atrium; LV = left ventricle.) The Annals of Thoracic Surgery 2013 95, e147-e149DOI: (10.1016/j.athoracsur.2012.11.027) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Operative findings and procedures. The thickened aortic left coronary cusp (LCC) was perforated. Right and noncoronary cusps (RCC, NCC) had thickened enrolling leaflet coaptation margins and huge central regurgitant gaps, partially resected for extension. Cusp extensions for all 3 leaflets were designed with autologous pericardium. (LM = left main; LV = left ventricle; MV = mitral valve; * = perforation with big fragile redundant fibrous tissue tags; ** = leaflet extension with autologous pericardium; # = thickening enrolling leaflet coaptation margin; ## = defect with fibrous tissue tag.) The Annals of Thoracic Surgery 2013 95, e147-e149DOI: (10.1016/j.athoracsur.2012.11.027) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Valve tissue and pathologic findings. (A) Fragile redundant fibrous tissue tags on the thickened left coronary cusp (A, solid white arrow). Right and noncoronary cusps had thickened enrolling leaflet coaptation margins (dotted white arrow). (B) Pathologic findings revealed fibromyxoid change of the aortic valve (black arrows) (Hematoxylin-eosin, magnification ×40). The Annals of Thoracic Surgery 2013 95, e147-e149DOI: (10.1016/j.athoracsur.2012.11.027) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Postoperative transthoracic echocardiography. (A, solid arrow) Good leaflet motion and (B, dotted arrow) trivial aortic regurgitation 2 months after operation. (aAo = ascending aorta; LV = left ventricle.) The Annals of Thoracic Surgery 2013 95, e147-e149DOI: (10.1016/j.athoracsur.2012.11.027) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions