P220 Behcet"s disease with right ventricular aneurysm

Abstract

Abstract Funding Acknowledgements Nil Introduction Behcet’s disease (BD) is a rare inflammatory disorder, which predominantly impacts people of Mediterranean and East Asian origin. While the aetiology is unknown, the prevailing disorder is vasculitis. Oral, skin and ocular lesions are common: cardiac involvement is rare. Case description A sixty-three year old male with Behcet’s disease (BD) presented for review. On clinical examination, atrial fibrillation, prominent V waves, mild pedal oedema and a ‘to and fro’ murmur were noted. Marked elevation of right ventricular (RV) end diastolic pressure was measured by cardiac catheter. Echocardiography and magnetic resonance imaging revealed significant RV abnormalities. The mid and apical RV regions were heavily trabeculated, and an anterior aneurysm was identified (see 2D image in abstract picture). A prominent horizontal muscular ridge in the basal RV was noted, and the RV outflow tract was narrowed. While the tricuspid valve was not apically displaced, leaflet coaptation was absent with subsequent severe tricuspid regurgitation into a grossly enlarged right atrium (see colour image in abstract picture). Management included diuretics and continuing immunosuppressives. Discussion BD is a rare (chronic) inflammatory disorder, which mainly affects people of Mediterranean and East Asian origin, and is often first diagnosed (in the third or fourth decades of life) following recurrent oral ulcerations, skin and ocular lesions. With BD, the prevailing disorder is vasculitis. Blood vessels of all sizes, both arteries and veins, are impacted: true or false aneurysms can occur. BD rarely affects the heart. If there is cardiac involvement, pericarditis is the most common lesion - others include myocarditis, mitral valve prolapse, intra-cardiac thrombus and myocardial infarction. We present a rare (and possibly unique) cardiac manifestation of BD, anterior RV aneurysm. Conclusion In this case report we present a rare cardiac manifestation of BD, anterior RV aneurysm. Abstract P220 Figure. Echocardiography Images