| Abstract [eng] |
Objective. To present a clinical case of aortic native and biological valve degeneration and review the literature. Description of the clinical case. A 54-year-old man presented to the Emergency Department with pain behind the sternum and reduced exercise tolerance. These symptoms started 3 months ago and are progressive. An ultrasound examination of the heart diagnosed a congenital anomaly of the aortic valve – bicuspid aortic valve with joint right and left coronary leaflets. The edge of the right and left coronary leaflet is flattened, prolapsing into the left ventricular outflow tract, and a mobile, ~ 8-9 mm long, mass is observed on the edge of the left coronary leaflet. A very large regurgitant eccentric flow towards the left ventricle posterior wall, and an acceleration of the anterograde flow (Vmax 2.4 m/s) were also recorded. Due to significant abnormalities on cardiac ultrasound, aortic valve replacement surgery was performed, and a Trifecta 27 mm biological valve was implanted. Eight years after implantation of an aortic valve biological prosthesis, the patient presented to the emergency department with a six-month history of progressive shortness of breath and reduced exercise tolerance. An ultrasound examination of the heart showed structural abnormalities of unknown origin in the biological aortic valve, possibly fibrotic or infectious lesions. A mild-moderate stenosis of the prosthesis (Vmax 4,2 m/s, Gmax 70,5 mmHg, Gvid 40,5 mmHg, effective orifice area 1,69 cm2, indexed effective orifice area 0,75 cm2/m2) and a probable mild regurgitation of prosthesis are recorded. Transoesophageal echocardiography aortic valve prosthesis findings: Vmax 4,4 m/s, Gmax 77 mmHg, Gvid 41 mmHg, effective orifice area 1,6 cm2. There is also evidence of a prolapse of the biological aortic valve prosthesis and significant regurgitation. The patient was treated surgically with a mechanical aortic valve replacement (Carbomedics reduced 25mm). The abnormalities seen on the instrumental examinations were confirmed: the right coronary leaflet of the aortic valve prosthesis was torn and prolapsed. Results. The clinical case describes a similar degeneration of the native and biological heart valve – during cardiac ultrasound recorded degeneration of the right coronary leaflet in the native and biological valve. Structural valve degeneration is defined as fibrocalcific remodelling, thickening, loss of mobility, rupture, or perforation of the valve leaflets. The degeneration of the heart valves is caused by various factors and combinations of them: mechanical, chemical, and immunological processes in the human body. One of these is shear stress, which alters the structure of the valve endothelium, which promotes valve degeneration. It is likely that that shear stress was the main cause of similar degeneration of native and biological heart valves. Conclusions. The number of aortic valve replacement surgeries is increasing worldwide, and the "ideal" biological heart valve prosthesis has not yet been developed. For this reason, it is important to further explore the processes that affect biological heart valves and cause their degeneration. |
