# Surgical Reintervention for Complex, Multivalvular Rheumatic Heart Disease

## TL;DR

This paper presents a case of complex heart valve surgery in a patient with rheumatic heart disease, highlighting the challenges and importance of multidisciplinary planning and shared decision making.

## Contribution

The paper emphasizes the role of shared decision making in managing complex multivalve rheumatic heart disease cases.

## Key findings

- Multivalve intervention in rheumatic heart disease is challenging and carries elevated surgical risk.
- Shared decision making and heart valve team planning are critical for successful outcomes.
- Postoperative complications like right ventricular dysfunction can prolong recovery.

## Abstract

Multivalve intervention carries elevated risk, particularly after prior valve surgeries.

A 52-year-old woman with rheumatic heart disease presented with progressive dyspnea. Multimodality imaging revealed severe bioprosthetic aortic valve regurgitation, severe bioprosthetic mitral valve stenosis, and severe tricuspid valve regurgitation. Although she was at increased surgical risk, the small size of her aortic valve prosthesis limited transcatheter options. She elected to undergo cardiac surgery, which included bioprosthetic Bentall and Commando procedures as well as tricuspid valve repair. Postoperative course was complicated by right ventricular dysfunction with prolonged hospitalization; however, she recovered and was discharged home.

This case demonstrates the challenges of multivalve intervention, despite comprehensive preparation including shared decision making and heart valve team planning.

Multidisciplinary planning for reintervention in multivalve disease can be complex without a single best solution. Shared decision making can help patients understand risks and make decisions aligned with their values.