ABSTRACT
A 43-year-old man came to the hospital because of increasing dyspnea for two weeks. At age nine months the patient was evaluated for failure to thrive, and a diagnosis of valvular aortic stenosis was made. At operation the aortic stenosis was found to be supravalvular, and the ascending aorta was enlarged with a Teflon patch, the proximal end of which was placed in the noncoronary sinus of Valsalva. The aortic valve was bicuspid but otherwise appeared normal. Postoperatively the patient did well until six years ago when he developed increasing dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. Echocardiography revealed a peak systolic pressure gradient across the aortic valve of 80 mmHg, severe aortic regurgitation, and moderate mitral regurgitation thought to be functional. Coronary arteriograms were normal. The patient underwent aortic valve replacement with a 23 mm Hancock 2 porcine heterograft prosthesis. He again did well postoperatively until a year before the current admission when dyspnea on exertion developed and culminated in two weeks of severe orthopnea and paroxysmal nocturnal dyspnea. The electrocardiogram (ECG) recorded on admission is shown in the Figure.
Subject(s)
Aortic Stenosis, Supravalvular/surgery , Atrioventricular Block/physiopathology , Electrocardiography , Heart Rate/physiology , Heart Valve Prosthesis Implantation/methods , Sinoatrial Node/physiopathology , Adult , Aortic Stenosis, Supravalvular/complications , Aortic Stenosis, Supravalvular/physiopathology , Atrioventricular Block/diagnosis , Atrioventricular Block/etiology , Cardiomyopathy, Dilated/complications , Cardiomyopathy, Dilated/diagnostic imaging , Cardiomyopathy, Dilated/physiopathology , Echocardiography, Doppler , Follow-Up Studies , Heart Atria/diagnostic imaging , Heart Atria/physiopathology , Humans , Male , Severity of Illness Index , Time FactorsSubject(s)
Angioplasty, Balloon, Coronary , Graft Occlusion, Vascular/diagnosis , Graft Occlusion, Vascular/therapy , Saphenous Vein/pathology , Aged , Coronary Angiography , Coronary Artery Bypass , Coronary Artery Disease , Diagnosis, Differential , Graft Occlusion, Vascular/pathology , Humans , Male , StentsABSTRACT
We report a rare case of mitral regurgitation as a result of perivalvular leak in a 49-year-old man with a history of blunt trauma. He presented with a 2-month history of progressive exertional dyspnea, angina, and heart failure. Preoperative transesophageal echocardiography demonstrated severe mitral regurgitation as a result of a perivalvular leak of the mitral valve that was not evident on transthoracic echocardiography and cardiac catheterization.