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Triple Valve Replacement in Patient with Rheumatic Heart Disease: Case report

Author : M.Limbong, A. Sariningrum A. Yudanto ,S. Fatah
Upload Date : 19-04-2018

Background: Tricuspid stenosis is almost always rheumatic in origin and is generally accompanied by mitral and aortic valve involvement. Triple valve replacement (TVR) is still deemed a complex and challenging choice for rheumatic heart disease (RHD) and carries significant mortality and morbidity.

Case Presentation : The patient is a 35-year-old woman with severe aortic regurgitation, severe mitral stenosis and severe tricuspid regurgitation and stenosis. She presented to RSUP dr.Kariadi with chief complain of heart failure that worsening in last three year. On physical examination the patient had diastolic murmur on erb area II/4, III/6 on apex and systolic murmur on LLSB. Echocardiography revealed a stenotic tricuspid valve with severe calcification. The patient went to triple valve replacement with mechanical valve St.Jude 25 in tricuspid, mechanical valve St.Jude 19 in aorta and mechanical valve St.Jude 25 in Mitral. During follow up in intensive care, creatinine level increase from 1.0 to 3.2 g/dl, but after 14 days treatment the creatinine level become 1.01 g/dl. Echocardiography was done before discharge and  every year. All mechanical prostetic valve in good function and  RV function was improved. The INR level maintained over 2.5 times. After three year with optimal medical therapy the heart failure symptoms had improved.

Conclution : In this case TVR for RHD appears to confer satisfactory short- and mid-term results with excellent symptomatic improvement. Increased experience with triple valve procedure, advances in the treatment of postoperative heart failure, intensive follow-up and extensive education on anticoagulation can be the reasons for the improvement in patient survival

KEYWORDS : triple valve replacement, rheumatic heart disease, congestive heart failure

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