Our Summary

This research paper is about a 34-year-old woman who was hospitalized due to difficulty breathing and chest pain. This woman had previously received an artificial aortic valve when she was 18 because her original valve was too narrow. When doctors examined her heart using an ultrasound, they discovered that the replacement valve was not functioning properly. Further tests revealed that the opening of the main artery supplying blood to the heart was also narrowed, which had caused a heart attack. During emergency surgery, doctors found excessive tissue growth around the artificial valve and over the opening of the main heart artery. They performed a complex heart surgery to replace the aortic valve and root, and to bypass the blocked artery. Fortunately, the woman recovered well from the surgery.

FAQs

  1. What is structural valve deterioration and how is it diagnosed?
  2. What is pannus formation and how does it relate to aortic valve replacement?
  3. What is the Bentall procedure and why was it performed in this case?

Doctor’s Tip

A helpful tip a doctor might tell a patient about aortic valve replacement is to closely monitor any changes in their symptoms and to follow up regularly with their healthcare provider for routine check-ups and echocardiograms to ensure the longevity and proper functioning of the replacement valve. It is also important for patients to maintain a healthy lifestyle, including regular exercise and a balanced diet, to promote overall heart health and reduce the risk of complications.

Suitable For

Patients who are typically recommended for aortic valve replacement include those with severe aortic stenosis or regurgitation, symptomatic patients with heart failure or chest pain, patients with severe valve dysfunction and left ventricular dysfunction, and patients with prosthetic valve dysfunction such as structural valve deterioration. Other factors that may indicate the need for aortic valve replacement include age, overall health status, and presence of other comorbidities. In some cases, urgent surgery may be required if there are complications such as acute myocardial infarction or severe valve dysfunction.

Timeline

Before:

  • Patient experiences symptoms such as shortness of breath and chest tightness and pain
  • Undergoes aortic valve replacement at the age of 18 for aortic stenosis
  • Transthoracic echocardiography shows left ventricular asynergy and high aortic valve pressure gradient, indicating structural valve deterioration

After:

  • Coronary computed tomography and coronary angiography reveal left main trunk ostial stenosis causing acute anteroseptal myocardial infarction
  • Urgent surgery reveals pannus formation around the prosthetic valve and covering the ostium of the left main trunk
  • Bentall procedure and coronary artery bypass grafting are performed
  • Postoperative course is uneventful

What to Ask Your Doctor

  1. What are the potential risks and complications associated with aortic valve replacement surgery?
  2. How long can I expect the new valve to last before needing a replacement?
  3. What lifestyle changes or precautions should I take after the surgery?
  4. Will I need to take any medications long-term after the surgery?
  5. How often will I need follow-up appointments to monitor the function of the new valve?
  6. Are there any specific symptoms or signs I should watch for that may indicate a problem with the new valve?
  7. What are the chances of developing pannus formation or other complications in the future?
  8. Are there any restrictions on physical activity or exercise after the surgery?
  9. Will I need to make any dietary changes to support my heart health post-surgery?
  10. Are there any alternative treatment options or procedures that could be considered in the future if needed?

Reference

Authors: Jinno T, Kato Y, Yamauchi H, Date Y, Sasaki K, Shimizu A, Kiyama H, Koyanagi T. Journal: Gen Thorac Cardiovasc Surg. 2021 Nov;69(11):1511-1514. doi: 10.1007/s11748-021-01704-3. Epub 2021 Sep 12. PMID: 34510334