Abstract
We report a case of early bioprosthetic valve calcification in a 76 year-old woman who had received supplementation with alfacalcidol, an analogue of vitamin D, for 3 years after her initial valve replacement. She underwent aortic valve replacement at the age of 71 and subsequently complained of shortness of breath. Ultrasonic cardiography revealed severe aortic stenosis and we performed a second aortic valve replacement with a bioprosthesis. Histopathologic and x-ray examination showed calcification on the explanted valve. She had not presented with any known risk for early bioprosthetic calcification, suggesting that vitamin D supplementation may accelerate calcification of bioprosthetic valves.
Highlights
Durability of bioprosthetic valve is increasing because valve tissue treatment and valve structure is improving from day to day, and actuarial freedom from explants due to valve deterioration at 20 years is reported as 81.5% in patients older than 64 years [1]
Case A 76 year-old women visited a hospital complaining of shortness of breath on effort. She had undergone aortic valve replacement (AVR) for aortic stenosis with a 21 mm Carpentier-Edwards Perimount (CEP, model 2900, Edwards Lifesciences, CA, USA) concomitant with coronary artery bypass grafting at the age of 71, 5 years previously
We could not find any reports of early prosthetic valve calcification in patients taking vitamin D supplementation, whereas it has been reported that administration of vitamin D caused the development of aortic stenosis in rabbits [4]
Summary
Durability of bioprosthetic valve is increasing because valve tissue treatment and valve structure is improving from day to day, and actuarial freedom from explants due to valve deterioration at 20 years is reported as 81.5% in patients older than 64 years [1]. Case A 76 year-old women visited a hospital complaining of shortness of breath on effort. She had undergone aortic valve replacement (AVR) for aortic stenosis with a 21 mm Carpentier-Edwards Perimount (CEP, model 2900, Edwards Lifesciences, CA, USA) concomitant with coronary artery bypass grafting at the age of 71, 5 years previously. Echocardiography (UCG) showed aortic stenosis with a maximum pressure gradient of 66 mmHg and an aortic valve area (AVA) of 0.80 cm. X-ray examination showed acinar calcification in the cusps of the explanted valves [Figure 2]. Arterial blood gas analysis showed a plasma free Ca2+ of Figure 2 Acinar and linear calcifications are found in the cusps by X-ray examination
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