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Narang N, Lang RM, Liarski VM, et al. Aortic Valve Replacement for Moderate Aortic Stenosis with Severe Calcification and Left Ventricualr Dysfunction-A Case Report and Review of the Literature. Front Cardiovasc Med. 2017;4:14doi: 10.3389/fcvm.2017.00014.
Narang, N., Lang, R. M., Liarski, V. M., Jeevanandam, V., & Hofmann Bowman, M. A. (2017). Aortic Valve Replacement for Moderate Aortic Stenosis with Severe Calcification and Left Ventricualr Dysfunction-A Case Report and Review of the Literature. Frontiers in cardiovascular medicine, 414. https://doi.org/10.3389/fcvm.2017.00014
Narang, Nikhil, et al. "Aortic Valve Replacement for Moderate Aortic Stenosis with Severe Calcification and Left Ventricualr Dysfunction-A Case Report and Review of the Literature." Frontiers in cardiovascular medicine vol. 4 (2017): 14. doi: https://doi.org/10.3389/fcvm.2017.00014
Narang N, Lang RM, Liarski VM, Jeevanandam V, Hofmann Bowman MA. Aortic Valve Replacement for Moderate Aortic Stenosis with Severe Calcification and Left Ventricualr Dysfunction-A Case Report and Review of the Literature. Front Cardiovasc Med. 2017 Mar 27;4:14. doi: 10.3389/fcvm.2017.00014. eCollection 2017. PMID: 28396860; PMCID: PMC5366320.
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Front Cardiovasc Med. 2017 Mar 27;4:14. doi: 10.3389/fcvm.2017.00014. eCollection 2017.

Aortic Valve Replacement for Moderate Aortic Stenosis with Severe Calcification and Left Ventricualr Dysfunction-A Case Report and Review of the Literature.

Frontiers in cardiovascular medicine

Nikhil Narang, Roberto M Lang, Vladimir M Liarski, Valluvan Jeevanandam, Marion A Hofmann Bowman

Affiliations

  1. Department of Medicine, Section of Cardiology, University of Chicago Medical Center , Chicago, IL , USA.
  2. Department of Medicine, Section of Rheumatology, University of Chicago Medical Center , Chicago, IL , USA.
  3. Department of Surgery, University of Chicago Medical Center , Chicago, IL , USA.

PMID: 28396860 PMCID: PMC5366320 DOI: 10.3389/fcvm.2017.00014

Abstract

A 55-year-old man with a history of erosive, seropositive rheumatoid arthritis (RA), and interstitial lung disease presented with shortness of breath. Echocardiography showed new-onset severe left ventricular (LV) dysfunction with an ejection fraction (EF) of 15% and moderately increased mean aortic valve gradient of 20 mmHg in a trileaflet aortic valve with severe sclero-calcific degeneration. Coronary angiography revealed no significant obstructive coronary disease. Invasive hemodynamic studies and dobutamine stress echocardiography were consistent with moderate aortic stenosis. Guideline directed medical therapy for heart failure with reduced EF was initiated; however, diuretics and neurohormonal blockade (beta-blocker and angiotensin receptor blocker) provided minimal improvement, and the patient remained functionally limited. Of interest, echocardiography performed 1 year prior to his presentation showed normal LV EF and mild aortic leaflet calcification with moderate stenosis, suggesting a rapid progressing of calcific aortic valve disease. Subsequently, the patient underwent surgical aortic valve replacement and demonstrated excellent postsurgical recovery of LV EF (55%). Calcific aortic valve disease is commonly associated with aging, bicuspid aortic valve, and chronic kidney disease. Pathophysiological mechanism for valvular calcification is incompletely understood but include osteogenic transformation of valvular interstitial cells mediated by local and systemic inflammatory processes. Several rheumatologic diseases including RA are associated with premature atherosclerosis and arterial calcification, and we speculated a similar role of RA accelerating calcific aortic valve disease. We present a case of accelerated aortic valve calcification with (only) moderate stenosis, complicated by a rapid decline in LV systolic performance. Guidelines for AVR in moderate stenosis without concomitant cardiac surgery are not well established, although it should be considered in selected patients.

Keywords: aortic stenosis; aortic valve replacement; calcific aortic valve disease; heart failure; rheumatoid arthritis

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