OBJECTIVES: To assess the clinical features, pathologic findings, postoperative results and the effects of immunosuppressive therapy in patients with Beh et's disease (BD). METHODS: We reviewed the postoperative course of the 9 BD patients who underwent a total of 17 aortic valve replacement procedures with prosthetic valves. RESULTS: Histological examination of the aortic valve commonly revealed diffuse myxoid degeneration (75 percent). Of 17 valve replacement surgeries, 13 surgeries resulted in complications, such as detachment of the prosthetic valve with perivalvular leakage and dehiscence of the sternotomy wound, within an average of 5 months (range from 1 month to 14 months). The rate of prosthetic valve detachment was 76 percent (13 of 17 surgeries). Four of the 9 patients (44 percent) who underwent aortic valve replacement procedures died of heart failure or infection associated with the detachment of the prosthetic valve, and perivalvular leakage within an average of 9 months. Aortic insufficiency associated with dehiscence of the prosthetic valve developed in 11 of 12 surgical cases (92 percent) with a mechanical valve and 2 of 5 surgical cases (40 percent) with tissue valves. Thirteen of 15 surgeries (87 percent) which were not given postoperative immunosuppressive therapy developed complications, while none of 2 surgeries that used postoperative immunosuppressive therapy with prednisolone (1 mg/kg/day) and azathioprine (100 mg/day) had these complications. CONCLUSION: The rates of prosthetic valve detachment in BD involving aortic valve were higher than those of other diseases. Aortic valve involvement was also one of the poor prognostic factors in BD. Intensive postoperative immunosuppressive therapy and surgical methods may be important factors for postoperative results.
Adult ; Aortic Valve/pathology ; Aortic Valve Insufficiency/*etiology/pathology ; Behcet Syndrome/*complications/drug therapy/pathology ; Female ; Heart Valve Diseases/*complications/pathology/surgery ; Heart Valve Prosthesis Implantation/*mortality ; Human ; Immunosuppression ; Male ; Postoperative Complications ; Prosthesis Failure ; Survival Analysis

OBJECTIVE: The purpose of this study was to use autopsy to explore cause of death and to identify medical errors after cardiac surgery. METHODS: Clinical and autopsy findings in 6 cases were analyzed with respect to the clinical diagnosis, operation types, death time and features, and autopsy findings, medico-legal disputes and related medical errors. RESULTS: There were total 6 patients. The procedures involve cardiac valve replacement (4), coronary artery bypass (1), and congenital aortic transposition repair (1). Three patients had sudden death one week after surgery and 3 from congestive heart failure. The findings include myocardial infarction (2), massive myocardial injury (1), endocarditis (2), and multi-organ failure (1). The families in all six cases suspected malpractice. The major concerns were operation indication and timing, selection of operation equipment, operative mishandling, inadequate post-operative care and timely therapeutic invention, inadequate informed consent regarding the severity of the disease itself, the risks of heart surgery, and its prognosis after the procedures. CONCLUSION Autopsy can be used to determine the cause of death, to assess the quality of the operation and post operation management, and to help to resolve malpractice disputes
Adult ; Aged ; Autopsy ; Cardiac Surgical Procedures ; Cause of Death ; Female ; Forensic Pathology ; Heart Diseases/surgery* ; Humans ; Infant ; Male ; Malpractice ; Medical Errors ; Middle Aged ; Mitral Valve Stenosis/surgery* ; Postoperative Complications ; Quality Control