Case Report
A 33-year-old Bangladeshi male referred to our hospital with a diagnosis
of progressive mitral regurgitation. Manifestations of his disease
include mild dyspnea with exercise. Laboratory findings were normal.
His first presentation was 4 years ago when he was admitted with fever,
atypical chest pain and vomiting. Physical examination at that time
revealed a blowing systolic murmur at the apex radiating to the left
axilla. Transthoracic (TTE) and transesophageal echocardiography (TEE)
confirmed a Bicuspid aortic valve with moderate AR, a moderate MR and a
15 mm vegetation attached to the mitral valve leaflets. Blood cultures
were positive for Streptococcus sanguinis, and the patient was managed
conservatively with antibiotics; his symptoms improved, and IE was
successfully treated conservatively.
Outpatient Echocardiographic follow-up subsequently showed same degree
of moderate mitral and aortic regurgitation but a marked increase in the
left ventricular diameters along preserved function. He lost follow up
for 2 years as he sustained COVID infection. He came back with worsening
shortness of breath and palpitation. Echocardiography showed severe
mitral regurgitation with two eccentric jets, the aortic valve as well.
So patient was scheduled for double valve surgery. CT aorta was done as
pre-operative routine for bicuspid aortic valve.
Intraoperative; Aortic valve was bicuspid with fused left and right
coronary cusps, Aortic root was slightly dilated with a redundant fused
aortic leaflet contributing to the regurgitation, but sinuses were not
dilated, and coronary ostium were anatomically normal. Additionally, a
single perforation was found in A3 segment of the mitral valve leaflet.
Aortic valve repair was performed with plication of the central and the
free edge of the fused right and left aortic cusp.
A synthetic pericardial patch was used to repair the perforation in A3
section of the anterior mitral valve leaflet, followed by implantation
of a 30mm Sorin Memo 4D annuloplasty ring. Intra-operative TEE confirmed
competent repair with trivial regurgitation in both valves and no
stenosis.
Patient recovery was unremarkable, he was discharged on the fifth
postoperative day.
He was seen in the outpatient clinic after 1 year from discharge, he was
doing very well with no complains. Post-operative echocardiographic
follow up revealed same finding of trivial Mitral and Aortic valve
regurgitations.