ISMICS - A Interesting Case Of Successful Valve In Valve Implantation In A Fracture Bio Prosthetic Valve

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A Interesting Case Of Successful Valve In Valve Implantation In A Fracture Bio Prosthetic Valve
Attaullah K. Niazi^¹, Mohammed Sharif Nassery^²;
^¹King Edward Medical University, Lahore, Pakistan, ^²French Medical Institute for Mothers and children, Kabul, Afghanistan

BACKGROUND: _{Presenting complaint:} _{• A 77-year-old male patient presents with breathlessness on exertion on walking one flight of stairs or greater since 2017.} _{Past medical history:}

_{Patient has a history of diabetes and hypertension.}

_{In 2008, the patient had an episode of NSTEMI followed by PCI with}

_{stenting of the mid-LAD.}

_{In 2013, the patient had another episode of NSTEMI followed by PCI with stenting of proximal LAD.}

_{In 2017, he had a worsening dyspnea with:}

_➢

_{Moderate mitral regurgitation with mild left ventricular systolic dysfunction.}

_➢

_{Progressive CAD, CABG (SVG graft to LAD and LCX-OM) with MVR (Bioprosthetic valve)}

_➢

_{Patient felt short of breath on moving uphill postoperatively and could cover a maximum of 1 km on level ground.}

METHODS: Investigations: • Trans-esophageal echocardiography was done. • NT Pro-BNP = 3000 pg/ml
• Mean PA pressure = 40 mmHg (Cath)
• Echo shows prosthetic valve dysfunction: ➢Bio-prosthetic valve thickened with restricted mobility. ➢Trans-mitral mean gradient = 11 mmHg
➢Mitral regurgitation • CT parameters are also shown
Procedure:

RESULTS:
6 month follow up: • Significant improvement in his symptoms • Mean mitral gradient = 4 mmHg
• No valve thrombosis
CONCLUSIONS:
• This case highlights a successful valve in valve implantation in a fractured bio- prosthetic valve to optimize the hemodynamic status. • Post Angiography, Fluroscopy and Echo

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