BRIEF COMMENTS
EXPERT: Prof. Roland Hetzer, MD, PhD
Affiliation: German Heart Instiute, Berlin, Germany
COMMENT
Considering the current symptoms, impairment of exercise tolerance is most probably the result of mitral regurgitation, rather than peripheral artery disease. Mitral valve replacement is recommended.
EXPERT: Paweł Rubiś, MD, PhD
Affiliation: Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
COMMENT
Coexistence of two diseases (atherosclerosis and vasculitis) cannot be excluded. However, there are no signs of active inflammatory process and major risk factors of atherosclerosis are present. Steroid treatment or immunotherapy is not indicated.
EXPERT: Grzegorz Kopeć, MD, PhD
Affiliation: Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
COMMENT
Current findings are against vasculitis. It is not impossible that iliac artery obstruction resulted from past peripheral thrombembolia (large left atrium is a risk factor).
EXPERT: Prof. Henryk Siniawski, MD, PhD
Affiliation: German Heart Instiute, Berlin, Germany
COMMENT
The major issue at the moment is mitral and tricuspid regurgitation. Valvular disease in this patient should be treated surgically. Myocardial biopsy might shed some light on the vasculitis concept although the condition is most probably not active at present. Further diagnostics are recommended.
EXPERT: Prof. Piotr Podolec, MD, PhD
Affiliation: Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
COMMENT
The performed autoimmunological tests are negative and the suspected vasculitis is apparently not active. Illiac artery obstruction could have indeed been caused by thrombus in the past than by vasculitis. The presented case is a very interesting one and should be followed during the future CRCD meetings.
CONCLUSIONS
1.Cardiosurgical treatment of mitral and tricuspid regurgitations is recommended. Myocardial biopsy and histopathological tests might be contributory to the precise diagnosis.
2.Due to lack of evidence of active vasculitis at present immunotherapy or steroid administration is not advised.
3.The patient will require further diagnostic process after cardiosurgical management of the valvular disease.
EXPERTISE 1
“Development of the European Network in Orphan Cardiovascular Diseases”
„Rozszerzenie Europejskiej Sieci Współpracy ds Sierocych Chorób Kardiologicznych”
