Surgical Reintervention for Complex, Multivalvular Rheumatic Heart Disease.

BACKGROUND

Multivalve intervention carries elevated risk, particularly after prior valve surgeries.

CASE SUMMARY: A 52-year-old woman with rheumatic heart disease presented with progressive dyspnea. Multimodality imaging revealed severe bioprosthetic aortic valve regurgitation, severe bioprosthetic mitral valve stenosis, and severe tricuspid valve regurgitation. Although she was at increased surgical risk, the small size of her aortic valve prosthesis limited transcatheter options. She elected to undergo cardiac surgery, which included bioprosthetic Bentall and Commando procedures as well as tricuspid valve repair. Postoperative course was complicated by right ventricular dysfunction with prolonged hospitalization; however, she recovered and was discharged home.

DISCUSSION: This case demonstrates the challenges of multivalve intervention, despite comprehensive preparation including shared decision making and heart valve team planning.

TAKE-HOME MESSAGES: Multidisciplinary planning for reintervention in multivalve disease can be complex without a single best solution. Shared decision making can help patients understand risks and make decisions aligned with their values.