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• W57201500 abstract "We appreciate the interest showed by Polat and Polat [1Polat A. Polat E.B. An adolescent with aortic regurgitation caused by Behçet's disease (letter).Ann Thorac Surg. 2014; 97: 737-738Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar] in our article [2Kang H.M. Kim G.B. Jang W.S. et al.An adolescent with aortic regurgitation caused by Behçet's disease mimicking endocarditis.Ann Thorac Surg. 2013; 95: e147-e149Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar]. As they noted, preoperative use of corticosteroids and continuous postoperative steroid therapy in patients with Behçet's disease (BD) is essential to improve treatment outcome for valve surgery [3Jeong D.S. Kim K. Kim J.S. Ahn H. Long-term experience of surgical treatment for aortic regurgitation attributable to Behçet's disease.Ann Thorac Surg. 2009; 87: 1775-1782Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar]. In our patient, we also prescribed prednisolone for 3 weeks prior to aortic valvuloplasty and maintained the prednisolone administration for 6 months after the operation to sustain a low-inflammation state [2Kang H.M. Kim G.B. Jang W.S. et al.An adolescent with aortic regurgitation caused by Behçet's disease mimicking endocarditis.Ann Thorac Surg. 2013; 95: e147-e149Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar]. As we suggested, early diagnosis is crucial for initiating immunosuppressive therapy before valve surgery to improve the long-term outcome for the treated valve. With regard to coagulation, the patient in our report did not experience any thrombotic event before or after operation. The baseline preoperative coagulation study showed normal findings (prothrombin time international normalized ratio, 1.03; activated partial thromboplastin time 35.8 seconds). After the aortic valvuloplasty, the patient was briefly treated with warfarin for 1 week, after which the treatment was changed to an antiplatelet drug (triflusal). As Polat and Polat [1Polat A. Polat E.B. An adolescent with aortic regurgitation caused by Behçet's disease (letter).Ann Thorac Surg. 2014; 97: 737-738Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar] suggested, the potential for the development of thrombosis in BD patients is well known. Endothelial lesions in BD patients, increased procoagulant activity, and hypofibrinolysis have been suggested as the likely causes for potential thrombosis development [4Harman E. Sayarlıoglu M. Harman M. Sayarlıoglu H. The evaluation of coagulation parameters and vessel involvement in Behcet's disease. A clinical experience of Behcet' s disease: study of 152 cases. Acta Med Iran. 2013; 51: 215-223Google Scholar]. As Polat and Polat also noticed, our patient was diagnosed with BD shortly before operation. Because of the patient's relatively young age, it is difficult to think of BD as a cause of the valve lesion. In addition, this patient lacked the symptoms to fulfill the International Study Group criteria [5Criteria for diagnosis of Behçet's disease. International Study Group for Behçet's Disease.Lancet. 1990; 335: 1078-1080Abstract PubMed Scopus (4112) Google Scholar]. However, his characteristic echocardiographic findings, along with elevated ESR and human leukocyte antigen-B51 positivity, appeared to be sufficient for a diagnosis of BD. If the diagnosis of BD had been delayed in this patient, he may have developed other typical symptoms and signs of BD in the future. An Adolescent With Aortic Regurgitation Caused by Behçet's DiseaseThe Annals of Thoracic SurgeryVol. 97Issue 2PreviewWe have read the case report about an adolescent patient with aortic regurgitation secondary to Behçet's disease (BD) by Kang and colleagues [1] in a previous issue of The Annals. Valvular pathologies secondary to BD are frequent in certain populations, as they pointed out. The reported case is a well-managed case and the differential diagnosis and operation are interesting as for the surgeons working in the related populations. However, there are some issues that need to be clarified. First, no information about the coagulation studies is present in the report. Full-Text PDF" @default.
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• W57201500 doi "https://doi.org/10.1016/j.athoracsur.2013.11.032" @default.
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