Zhongshan Hospital , Fudan University Zhongshan Hospital , Fudan University

Shanghai Cardiovascular Disease InstitutShanghai Cardiovascular Disease Institute

Guan Lihua, Zhou Daxin, Ge Junbo Guan Lihua, Zhou Daxin, Ge Junbo

Patient Demographics and Patient Demographics and Medical HistoryMedical History

Male, 69 yearsMale, 69 years

Coronary artery angiography: normalCoronary artery angiography: normal

Hypertention: YHypertention: Y

Clinical PresentationClinical PresentationRecurrent chest oppression and tachypnea for 29 years,

aggravate 3 years

1980s diagnosised as rheumatic heart diease

17th, Aug, 1999s, mechanical prosthetic valve replacement of MV and AV

7th, Sep, 1999s, pacemaker implantation because of AF complicated with long pause

Recurrent edema of lower limbs 1year

Physical examinationBP 140/80mmHg ， HR 82bpm, AF Engorgement of Jugular vein ， enlarged dullness of

heart, L2-3 III SM, L3-4 DM, R2-3 DM Moist rales of bilateral lungsSlight edema of both lower limbs.

Doppler Ultrasound14th, Sep, 1999s, enlarged LA 、 LV 、 RA,

LA49*59mm ， LV59mmLV59mm ， RA43mm 。 LVEF62%

12th, Oct, 2006s, stenosis and medium-severe perivalvular leakage of aotic mechanical valve. LA42mm ， LV55mmLV55mm ， RA52mm. PAsP51mmHg.

19th, Oct, 2009s ， medium-severe perivalvular leakage of aotic mechanical valve between right coronary sinus and no-coronary sinus . PAsP69mmHg with medium regurgitation of TV ， LA48mm ， LV61mmLV61mm, RA39mm ， enlarged RV ， LVEF58%。

angiographyPerivalvular leakage ø6mm*8mm, severe

regurgitation

14mm blockage

Doppler Ultrasound

Slight remanent aortic perivalvular leakage

PAsP 40mmHg

thanksthanks