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.