SHARE @ Advocate Health - Midwest - Scientific Day: Degeneration of a Bioprosthetic Mitral Valve 2 Years After Implantation
 

Affiliations

Advocate Lutheran General Hospital

Abstract

Introduction/Background:

Bioprosthetic mitral valve stenosis is a condition in which the mitral valve prosthesis becomes narrowed and difficult to open for both passive filling and active filling. This case is unique as there are very few articles published of fulminant bioprosthetic mitral valve failure only 2 years after implantation.

Description:

This is a case discussing a 67-year-old male with a past medical history of severe stenosis of a bioprosthetic 29mm Magna Ease mitral valve who presented with acute decompensated heart failure and found to have a completely degenerated bioprosthetic mitral valve two years after placement. After medical management, he was taken for surgical mitral valve replacement. This case report aims to discuss the mechanism, etiology, incidence, and prevalence of rapidly degenerated bioprosthetic mitral valves.

Discussion:

Modes of bioprosthetic valve degeneration include structural dysfunction (affecting the leaflets) or nonstructural (affecting the area around the leaflet but sparing the leaflets). Additional causes include thrombus and endocarditis. This patient was experiencing both etiologies with symptoms, with decreased leaflet mobility and pannus formation around the leaflets. Etiologies that may have led to rapid structural and non-structural bioprosthetic valve dysfunction in our patient include: uncontrolled hypertension, chronic kidney disease, diabetes mellitus, chronic smoking, excessive alcohol intake, atrial fibrillation, and increased mechanical wear and tear such as dilation of the left atrium and left ventricle. Other causes include hyperparathyroidism, end stage renal disease, and patient-prosthesis mismatch as our patient required an increased 31 mm replacement valve. Bioprosthetic heart valves do not have an ability for self-repair as native valves do and the lack of chordae tendinae attachments to the underside of the mitral valve can place greater stress on the bioprosthetic mitral valve, all leading to a higher grade of wear and tear over time.

Presentation Notes

Presented at Scientific Day; May 21, 2025; Park Ridge, IL.

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May 21st, 11:41 AM May 21st, 1:15 PM

Degeneration of a Bioprosthetic Mitral Valve 2 Years After Implantation

Introduction/Background:

Bioprosthetic mitral valve stenosis is a condition in which the mitral valve prosthesis becomes narrowed and difficult to open for both passive filling and active filling. This case is unique as there are very few articles published of fulminant bioprosthetic mitral valve failure only 2 years after implantation.

Description:

This is a case discussing a 67-year-old male with a past medical history of severe stenosis of a bioprosthetic 29mm Magna Ease mitral valve who presented with acute decompensated heart failure and found to have a completely degenerated bioprosthetic mitral valve two years after placement. After medical management, he was taken for surgical mitral valve replacement. This case report aims to discuss the mechanism, etiology, incidence, and prevalence of rapidly degenerated bioprosthetic mitral valves.

Discussion:

Modes of bioprosthetic valve degeneration include structural dysfunction (affecting the leaflets) or nonstructural (affecting the area around the leaflet but sparing the leaflets). Additional causes include thrombus and endocarditis. This patient was experiencing both etiologies with symptoms, with decreased leaflet mobility and pannus formation around the leaflets. Etiologies that may have led to rapid structural and non-structural bioprosthetic valve dysfunction in our patient include: uncontrolled hypertension, chronic kidney disease, diabetes mellitus, chronic smoking, excessive alcohol intake, atrial fibrillation, and increased mechanical wear and tear such as dilation of the left atrium and left ventricle. Other causes include hyperparathyroidism, end stage renal disease, and patient-prosthesis mismatch as our patient required an increased 31 mm replacement valve. Bioprosthetic heart valves do not have an ability for self-repair as native valves do and the lack of chordae tendinae attachments to the underside of the mitral valve can place greater stress on the bioprosthetic mitral valve, all leading to a higher grade of wear and tear over time.

 

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