Long-term results of aortic valve replacement: clinical case

Long-term results of aortic valve replacement: clinical case

E.V. Reznik^1,2, A.S. Smirnova¹, E.M. Jobava^3, D.V. Puzenko^1,4, A.P. Smirnov⁵ 

¹Pirogov Russian National Research Medical University, Moscow

²City Clinical Hospital No. 31, Moscow

³CREDE EXPERTO LLC, Moscow

⁴N.N. Blokhin National Medical Research Center of Oncology, Moscow

⁵City Polyclinic No. 212, Moscow

 Aortic regurgitation (AR, aortic valve insufficiency) is characterized by retrograde aortic blood flow to the left ventricle. The etiology of AR is diverse: congenital mitral valve anomalies and vascular malformations, aortic valve calcification, infectious endocarditis, myxomatous degeneration, acute rheumatic fever, aortic root dilation (with or without aortic valve disease), etc. Aortic valve replacement is a fundamental technique for the patient management with severe AR. This article presents a clinical case concerning the long-term results of aortic valve replacement in a young female patient with thrombophilia, warfarin resistance, acute myocardial infarction and acute cerebrovascular accident. The article also discusses the expediency of surgeries without valve preservation, the difficulties of patient management after valve replacement, the search for alternative treatment regimens in warfarin resistance, the possibility of rehabilitation and restoration of life quality. Emphasis is placed on the strict determination of indications for surgical intervention in patients with valvular heart diseases in accordance with national and international clinical guidelines. At the same time, it should be noted that EchoCG indicators that have changed during pregnancy are commonly reversible and can return to their initial values 3–6 months after delivery. When choosing a surgical intervention technique, it is important to take into account the benefits of valve-preserving reconstructive plastic surgeries on the cardiac valve. During determining the anticoagulant therapy regimen after valve replacement, it is necessary to diagnose/exclude thrombophilic conditions in a timely manner. Preferably, it is advised to manage such patients by a multidisciplinary team, including a cardiac surgeon, cardiologist and hematologist.

Keywords: aortic valve insufficiency, aortic regurgitation, valvular heart diseases, aortic valve replacement, complications, myocardial infarction, acute cerebrovascular accident, warfarin resistance, thrombophilia.

For citation: Reznik E.V., Smirnova A.S., Jobava E.M. et al. Long-term results of aortic valve replacement: clinical case. RMJ. 2023;4:28–32.