Keywords
aortic stenosis
acute coronary syndrome
ACS
structural valve degeneration
echocardiography
Abstract
Bioprosthetic valve stenosis is characterized by an increase in transvalvular velocity and pressure gradient alongside thickened or calcified leaflets. It is a condition typically observed after bioprosthetic heart valve implantation because of structural valve degeneration, a process that typically begins around 7–8 years post-implantation and can culminate in valve stenosis or regurgitation due to calcification, leaflet tear, or pannus formation. Uncommonly, bioprosthetic aortic valve (BAV) stenosis may provoke acute coronary syndrome (ACS)-like symptoms in patients, unrelated to coronary artery obstruction, possibly due to a supply-demand mismatch impacting coronary vasculature, particularly under conditions of tachycardia and myocardial hypertrophy. A case illustration featuring a 67-year-old woman with BAV stenosis experiencing ACS-like symptoms 9 years post-surgical aortic valve replacement highlights the diagnostic challenges. Unstable angina and cardiac biomarker results were suggestive of ACS, but transthoracic echocardiogram (TTE) revealed a moderately stenotic BAV in the patient. A significant decrease in left ventricular ejection fraction and left ventricular stroke volume over time, compared with prior TTE assessments across the years, signifies the hemodynamic compromise linked to BAV stenosis. Adhering rigorously to American College of Cardiology/American Heart Association guidelines mandating routine TTE evaluations at 5- and 10-year intervals post-implantation and yearly thereafter for all BAV recipients, regardless of clinical status, is imperative to avert potential complications. Thus, prioritizing early detection of valve dysfunction via TTE in suspected ACS patients with prior BAV placement is crucial in devising optimal treatment strategies and enhancing patient care.
Acknowledgements
The authors wish to express their deepest gratitude to the medical staff of the Cardiology Department of the City Clinical Hospital No. 31 named after Academician G. M. Savelyeva (Moscow), which actively participated in treating the patient.
For citation
Yeo MAH, Zhuravlev AC. Cardiovascular conundrum: Discovering bioprosthetic valve stenosis in a 67-year-old woman with acute coronary syndrome presentation. USMU Medical Bulletin. 2024;(4):67–79. EDN: https://elibrary.ru/KNYCRF.
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