A 31-year-old male, presented with history of dyspnea on exertion and chest pain (NYHA class III) and was diagnosed to have severe aortic stenosis and regurgitation, moderate to severe mitral stenosis and tricuspid valve stenosis. After initial stabilization and symptomatic improvement, the patient underwent coronary angiogram that showed normal coronaries. He was posted for triple valve surgery.

Surgical Procedure

Patient underwent triple valve procedure of aortic valve replacement with 21mm carbomedics mechanical valve, mitral valve replacement with 25mm carbomedics mechanical valve and tricuspid valve repair with 30mm MC3 ring. He made an uneventful postoperative recovery and was discharged after two weeks.

Discussion

Rheumatic heart disease (RHD) is a significant cause of cardiac operations in developing countries. Cardiac valve surgeries for RHD account for a significant portion of valve surgeries. Triple valve replacement (TVR) is deemed a complex and challenging choice for rheumatic heart disease (RHD) and carries significant mortality and morbidity. The challenge for surgeons is the prolonged cardio-pulmonary bypass (CPB) and myocardial ischaemic times. In-hospital mortality rate of about 10–12% has been reported. Advances in myocardial protection and CPB techniques, use of new generation valves, improvements in surgical techniques along with advances in perioperative and postoperative care can be credited for the improvement in early survival after triple valve surgery. Increased experience with triple valve procedures, advances in the treatment of postoperative heart failure, intensive patient follow-up, and extensive education on anticoagulation are also reasons for the improvement in patient survival.

Triple valve surgery