Abstract
Heart valve replacement is a common cardiac surgical procedure used to treat native valvular diseases such as aortic and mitral stenosis and regurgitation. These procedures reduce the morbidity and mortality associated with diseased native valves and yet come at the expense of prosthetic valve complications. Structural valve degeneration is one such complication. We present a case of a critically ill elderly man who had undergone mitral valve replacement 14 years prior to his current presentation. Only after admission through the emergency department was a transesophageal echocardiogram obtained and the diagnosis of prosthetic valve degeneration made. He subsequently underwent successful replacement of his diseased prosthetic valve.
Highlights
A 68-year-old male was presented to the emergency department with acute shortness of breath and hypoxia after a 2-day prodrome of general malaise
The patient’s medical history was significant for Type II diabetes mellitus, hypertension, hyperlipidemia, chronic renal insufficiency, non-sustained ventricular tachycardia, and psoriatic arthritis. His surgical history included bioprosthetic mitral valve replacement (Hancock porcine) with simultaneous implantation of an implantable cardioverter-defibrillator (ICD) 14 years prior to presentation. He had recently underwent an upgrade to a dual-chamber ICD four months before it was complicated by right ventricular lead malfunction requiring replacement one month later
Chest radiography showed pulmonary edema and bilateral lower lobe consolidation. He was admitted to the medical intensive care unit (MICU) with pa provisional diagnosis of pneumonia
Summary
The patient’s medical history was significant for Type II diabetes mellitus, hypertension, hyperlipidemia, chronic renal insufficiency, non-sustained ventricular tachycardia, and psoriatic arthritis His surgical history included bioprosthetic mitral valve replacement (Hancock porcine) with simultaneous implantation of an implantable cardioverter-defibrillator (ICD) 14 years prior to presentation. He had recently underwent an upgrade to a dual-chamber ICD four months before it was complicated by right ventricular lead malfunction requiring replacement one month later. Blood cultures did not grow an organism, and infectious disease consultation was ordered with determination that valvular endocarditis was highly unlikely and that structural valvular degeneration (SVD) was more likely the cause for his mitral regurgitation Given his acute presentation without clinical evidence of endocarditis and yet a 14year-old prosthetic valve, this was mostly acute upon chronic SVD. He was extubated on postoperative day 6, and discharged home on postoperative day 21 without sequellae
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
