AN UNUSUAL CASE OF SEVERE RHEUMATIC TRICUSPID STENOSIS ASSOCIATED WITH SEVERE MITRAL STENOSIS: A HEMODYNAMICALLY CHALLENGING SITUATION

Background: Tricuspid stenosis is a rare valvular disease that is seldom isolated and is most frequently associated with mitral valve involvement. Although rheumatic fever primarily affects the cardiac valves, other cardiac structures may also be involved during rheumatic carditis.
Case summary: We report the case of a 38-year-old man with no cardiovascular risk factors and a history of recurrent childhood tonsillitis, acute rheumatic fever, and hypothyroidism treated with levothyroxine. He was admitted to the cardiac intensive care unit for acute congestive heart failure. Transthoracic echocardiography revealed severe mitral stenosis associated with severe tricuspid stenosis and left ventricular systolic dysfunction. The coexistence of these lesions resulted in a particularly complex hemodynamic situation, making surgical decision-making challenging.
The patient underwent mechanical mitral valve replacement combined with tricuspid bioprosthetic valve replacement, with an uneventful postoperative recovery.