A case report of successful surgical treatment of mitral valve disease 38 years after implantation of ball-valve mechanical prosthesis in aortic position

The application of ball-valve prostheses in clinical practice marked a new age in the treatment of valvular heart pathology. Ball-valve prostheses are made of long-living and hard-wearing materials; however, these properties confer significant disadvantages resulting from the large dimensions and weight, increased pressure gradient and risk of valve thrombosis and systemic embolism. With the advent of more advanced disk structures, the use of ball-valve prostheses was ended. In Russia and other counties, the scientific literature shows an increase in reoperation after implantation of ball-valve prostheses over the long-term, which is associated with the occurrence of another valve defect. The need to replace a functioning ball-valve prosthesis with a modern mechanical or biological prostheses during surgery for another valve is still controversial. We present a case report of a 55-year-old patient with rheumatic mitral stenosis and functional insufficiency of the tricuspid valve, who underwent repeat surgery 38 years after implantation of a ball-valve prosthesis in the aortic position. From the echocardiography findings, the peak transmitral gradient was 16 mm Hg, the average gradient was 5.5 mm Hg, the area was 1.3 cm2 and regurgitation was third-degree. On the tricuspid valve, there was third-degree regurgitation. Adequate hemodynamic parameters of the ball-valve prosthesis (the maximum blood flow rate was 2.65 m/sec, the peak gradient was 30 mm Hg, the average gradient was 18 mm Hg and there was no regurgitation) and the absence of valvedependent complications enabled us to perform mitral prosthetics and tricuspid valve plastic surgery without replacing the aortic prosthesis, which reduced the operation time and decreased the risk of complications. The patient was examined two years later. The patient’s active lifestyle and adequate hemodynamic parameters proved the rationality of our treatment policy. The reported case indicates that mitral valve defect that develops a long time after aortic valve prosthetics can be treated surgically without the replacement of a ball-valve prosthesis in the case that it has good function.