Flanged Bentall procedure for paravalvular leakage and pseudoaneurysm after root replacement in Behcet’s disease and infective endocarditis: a case report

BACKGROUND: Behcet’s disease is a multi-systemic inflammatory disorder. Paravalvular leakage and aortic pseudoaneurysm are rare in patients with Behcet’s disease after aortic root replacement. Complicated post-operative infective endocarditis can make the treatment more difficult. We applied a flanged Bentall procedure to treat one such case. CASE SUMMARY: A 27-year-old man with aortic regurgitation and Behcet’s disease underwent aortic root replacement. Post-operative electrocardiogram showed a complete atrioventricular block. One year after the operation, he underwent percutaneous temporary pacemaker implantation and endovascular stent graft exclusion because of pseudoaneurysm of the ascending aorta. Post-operative fever and blood culture confirmed infective endocarditis. Examination showed paravalvular leakage and pseudoaneurysm recurrence. Then, the patient underwent a third operation in our hospital. Aortic root replacement with a flanged composite valved conduit was performed. Immunosuppressants and antibiotic treatment were given after surgery. After 3 months, the cardiovascular examination was normal, and the patient was in good condition. DISCUSSION: Surgical treatment of aortic regurgitation caused by Behcet’s disease was characterized by a high rate of paravalvular leakage, which led to reoperation and high mortality. Combined infective endocarditis would further increase the difficulty and risk of treatment. It is important to maintain effective immunosuppressive therapy while monitoring serum biomarkers and inflammation indicators. The potential hazards of immunosuppressants are increased risk of infection and poor tissue healing. In our case, targeted antibiotic treatment and appropriate immunosuppressive therapy were well balanced. The flanged Bentall procedure was also the key to success, which could increase aortic effective orifice area and reduce the risk of dehiscence.