Triple Valve Rheumatic heart disease with inflammatory Aortitis: Case Report and Surgical Treatment
HARSHBIR S. P. PANNU, Mch.1, Anvesh R. K. S. Gandhi, MD Phd.1, Harleen K. Kaur, MD2. 1HOLY HEART HOSPITAL & SUPER-SPECIALITY CENTRE, Amritsar, India, 2Nijjer Diagnostic and Imaging Centre, Amritsar, India. Patient Demographics: A 35 yr old female
Relevant History: Presented with NYHA III/IV breathlessness on exertion and Palpitations.She also shared history of Orthopnoea and paroxysmal nocturnal dyspnoea .She gave history of rheumatic fever about two decades ago..Physical exam echocardiogram revealed severe MITRAL AORTIC AND TRICUSPID STENOSIS with pulmonary hypertension. CT angiogram revealed small saccular aneurysms of ascending aorta. Pre-Operative Plan: Tripple valve surgery with replacement of ascending aorta was planned
Discussion of what was actually done and the challenges, deaths and complications encountered. (Unless case is still pending): Mitral and Aortic valves were replaced with Bi-leaflet mechanical prosthesis and Tricuspid valve was repaired. Ascending aorta was wrapped with a prosthetic graft to reduce aortic cross clamp time. This was done as the wall of aorta was healthy ( diameter of aorta was 3.8 cm) by and large except the two areas of breaks in adventitia layer measuring 8 x 4 mm and 5x5 mm.
Patient made an eventless recovery with extubation after 24 hrs and discharge on 8 th post op day and is well 4 months after surgery
Focal Aortitis is a newly recognised entity and its association with valvular rheumatic heart disease has not been reported.
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