Bioprosthetic valve dysfunction due to leaflet rupture

Patients with bioprosthetic heart valves have low rates of thrombosis and hemorrhagic complications. However, bioprostheses have limited long-term durability due to structural deterioration. A 74-year-old woman was admitted with resting dyspnea, orthopnea, palpitation, and hemoptysis of three days' duration. She had undergone closed and open mitral commissurotomies due to rheumatic mitral stenosis in 1962 and 1988, respectively, and mitral valve replacement (MVR) with a bioprosthetic valve at the age of 66 years. Electrocardiography revealed atrial fibrillation. Transthoracic echocardiography demonstrated a massively enlarged left atrium and severe eccentric mitral regurgitation (MR) with valvular and paravalvular components. Transesophageal echocardiography showed primary valve degeneration, leaflet rupture, and severe MR. Coronary angiography showed normal coronary arteries and third-degree MR. The patient was reoperated and a 29-mm porcine bioprosthesis was implanted. The operative material confirmed rupture of one leaflet.