Autoimmune-associated early double bioprosthetic valve failure: A case report.
Sarah Guo, Hazem Aljasem, Hani Ali-Ghosh et al.
✦ AI-curated · Sources linked
Case in brief
A 70-year-old man developed severe heart failure four years after bioprosthetic replacement of both the mitral and aortic valves. Imaging showed structural degeneration of both prostheses, prompting high-risk redo surgery. After cardiopulmonary bypass, he developed profound systemic inflammatory response syndrome that did not respond to vasopressors or steroids and died within 24 hours. Further testing found elevated isolated anti-cardiolipin IgM antibodies, raising suspicion that autoimmune-associated valve thrombosis may have contributed to the early degeneration.
What made this case unusual
Both bioprosthetic valves showed early structural degeneration, with isolated anti-cardiolipin IgM elevation suggesting a possible autoimmune contribution; the postoperative course was complicated by refractory systemic inflammation and death.
Diagnostic / clinical pearl
When bioprosthetic valve degeneration occurs early, consider a thorough evaluation for potential contributors, including autoimmune-associated thrombosis, while recognising that antibody findings in a single case do not establish causation.
Why it matters
The case also underscores that severe inflammatory complications can follow cardiopulmonary bypass and may be difficult to manage.