Excerpt

Valvular heart disease progresses slowly and generally remains asymptomatic. There is currently no medical cure for valvular disease. As lifestyle modifications and medications can only reduce the associated symptoms, surgery is generally required [1]. When valve repair techniques are not an option, valve replacement with mechanical or biologic prosthetic valves is inevitable. Despite the development of new operative and myocardial protection techniques, multiple valve surgery for advanced rheumatic heart disease (RHD) remains challenging. These patients are usually in the end stage of disease, and are often subjected to a long duration of cardiopulmonary bypass and prolonged myocardial ischemia during a complex operation [2, 3]. Furthermore, compared with the replacement of a single valve, the rates of long-term morbidities, such as thromboembolism, anticoagulation-related hemorrhage, endocarditis, and paravalvular leakage, are higher after multiple valve replacement [4]. Here, we report a rare case of a patient who underwent quadruple valve replacement for RHD 20 years ago. To the best of our knowledge the patient’s survival time after surgery is the longest described among the current reports of quadruple valve replacement. …