Quadruple valve replacement with mechanical valves: an 11-year follow-up study.
BACKGROUND
We performed the first quadruple valve replacement with mechanical valves, combined with the correction of complex congenital heart disease on November 17, 1999. We report here the 11-year follow-up study.


METHODS
A 47-year-old man with subacute rheumatic endocarditis, a ventricular septal defect, and an obstruction of the right ventricular outflow tract required replacement of the aortic, mitral, tricuspid, and pulmonary valves; repair of the ventricular septal defect; and relief of the obstruction of the right ventricular outflow tract. The surgery was done on November 17, 1999, after careful systemic preparation of the patient. Warfarin therapy with a target international normalized ratio (INR) range of 1.5 to 2.0 was used. Follow-up included monitoring the INR, recording the incidences of thromboembolic and bleeding events, electrocardiography, radiography, and echocardiography evaluations.


RESULTS
The patient's INR was maintained between 1.5 and 2.0. All 4 mechanical prosthetic heart valves worked well. He is in generally good health without any thromboembolic or bleeding complications.


CONCLUSIONS
Long-term management is challenging for patients who have experienced quadruple valve replacement with mechanical valves; however, promising results could mean that replacement of all 4 heart valves in 1 operation is feasible in patients with quadruple valve disease, and an INR of 1.5 to 2.0 could be appropriate for Chinese patients with undergoing valve replacement with mechanical valves.
Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Yukun
Y
Cao
Chunhu
C
Gu
Guocheng
G
Sun
Shiqiang
S
Yu
Hongbing
H
Wang
Dinghua
D
Yi
D001021:Aortic Valve / Q000601:surgery*; D003131:Combined Modality Therapy; D004696:Endocarditis / Q000150:complications / Q000601:surgery; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000601:surgery; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011664:Pulmonary Valve / Q000601:surgery*; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*; D014694:Ventricular Outflow Obstruction / Q000150:complications / Q000601:surgery