When should asymptomatic patients with combined severe aortic stenosis and aortic insufficiency undergo valve replacement? A clinical case.
Indications to prosthetic aortic valve implantation in patients with aortic stenosis or aortic regurgitation or both stenotic or regurgitant aortic valve, who present without symptoms, are controversial. We present the case of an asymptomatic patient with combined severe aortic stenosis and an equally important insufficiency, undergoing surgery for valve substitution with a bileaflet prosthesis. After surgery he was treated with warfarin according to the doses recommended and underwent follow-up with clinical and echocardiographic exams. Eight months after intervention the patient had an embolic stroke with aphasia and right hemiplegia, despite the therapeutic level of INR. At present, even though he has partly recovered motor function, he reports a noteworthy decline in life quality, because of the persistent speech difficulties. We use this case as the starting point for a discussion of the chance of referring patients affected by aortic valvulopathy to valve substitution, in the absence of symptoms.
Department of Cardiology, University of Turin, Turin, Italy.
A
A
Gerasimou
E
E
Oliaro
C
C
Quaglia
M
M
Canta
M
M
Calachanis
M
M
Morello
L
L
Mangiardi
D000925:Anticoagulants / Q000627:therapeutic use; D001022:Aortic Valve Insufficiency / Q000150:complications* / Q000188:drug therapy / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000188:drug therapy / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011379:Prognosis; D012720:Severity of Illness Index; D013997:Time Factors; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin