Abstract
The patient was a male in his 60s. He was on hemodialysis for end-stage renal failure due to IgA nephropathy and had a history of chronic hepatitis C and hypertension. Two years after undergoing aortic valve replacement (AVR) with a bioprosthetic valve (CEP Magna EASE 23 mm) for severe aortic regurgitation due to the presence of right coronary cusp prolapse, he developed chest discomfort on exertion and hypotension during dialysis. Transthoracic echocardiography (TTE) performed at a routine outpatient clinic showed marked calcification of the biological valve and limited patency, with a significant increase in peak velocity of 5.32 m/sec at the prosthetic valve site. Then, a diagnosis of structural valve deterioration (SVD) was made, and a mechanical valve replacement (ATS AP360 22 mm) was performed. The patient had a good postoperative course and was discharged on postoperative day 21. It has been reported that dialysis patients are prone to cardiovascular calcification and atherosclerosis, resulting in earlier SVD. In the present case, the maximum blood flow velocity at the prosthetic valve site increased to 2.91 m/sec at TTE 1 year postoperatively, confirming severe prosthetic valve stenosis at 2 years postoperatively. Short-term follow-up of TTE after AVR in hemodialysis patients should be considered. In conclusion, frequent follow-up with TTE and monitoring changes in Doppler indices are essential for early diagnosis of SVD after AVR in hemodialysis patients. The findings from this case study will contribute to improving management methods after AVR in dialysis patients.
