A rare differential diagnosis of aortic stenosis with a black aortic valve: A case report

Zarin S. Rangwala, Bineesh K. Radhakrishnan, Pruthvi S. Patel, Prasanta K. Dash, G. Gayathri, Vivek V. Pillai
{"title":"A rare differential diagnosis of aortic stenosis with a black aortic valve: A case report","authors":"Zarin S. Rangwala, Bineesh K. Radhakrishnan, Pruthvi S. Patel, Prasanta K. Dash, G. Gayathri, Vivek V. Pillai","doi":"10.1186/s43044-024-00553-8","DOIUrl":null,"url":null,"abstract":"Cardiac ochronosis, presenting as a rare manifestation of alkaptonuria, an autosomal recessive disorder, is characterised by black pigmentation of calcified cardiac valves and atherosclerotic plaques. We report an intraoperative dilemma on the discovery on the black aortic valve in a case of an old lady with degenerative calcific aortic stenosis. A 60-year-old lady was electively admitted for valve replacement with a bioprosthetic valve for severe aortic stenosis. She was symptomatic with complaints of headache and giddiness and had a pressure gradient of 113/17mmhg across the aortic valve. Intraoperatively, she was found to have cardiac ochronosis on the discovery of pigmented aortic intima extending to the valve leaflets and underwent valve replacement with a mechanical prosthetic valve. She was post-operatively evaluated for the same and diagnosed with alkaptonuria. Though the surgery went uneventful and the patient was discharged without any complication, she was advised to be on regular follow-up to assess valve gradients, paravalvular leaks and to monitor the disease progression. The presented case sheds light on the rare cardiac manifestation of alkaptonuria. In the absence of definitive pre-operative diagnosis, intraoperative findings played a pivotal role in guiding the surgical approach and choice of prosthetic valve. The decision to use a mechanical valve was influenced by the potential risks associated with bioprosthetic valves in the setting of ochronosis. Ongoing follow-up and monitoring are essential to assess the durability of the chosen prosthetic valve and to manage any long-term consequences of the underlying metabolic condition.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Egyptian Heart Journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s43044-024-00553-8","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Cardiac ochronosis, presenting as a rare manifestation of alkaptonuria, an autosomal recessive disorder, is characterised by black pigmentation of calcified cardiac valves and atherosclerotic plaques. We report an intraoperative dilemma on the discovery on the black aortic valve in a case of an old lady with degenerative calcific aortic stenosis. A 60-year-old lady was electively admitted for valve replacement with a bioprosthetic valve for severe aortic stenosis. She was symptomatic with complaints of headache and giddiness and had a pressure gradient of 113/17mmhg across the aortic valve. Intraoperatively, she was found to have cardiac ochronosis on the discovery of pigmented aortic intima extending to the valve leaflets and underwent valve replacement with a mechanical prosthetic valve. She was post-operatively evaluated for the same and diagnosed with alkaptonuria. Though the surgery went uneventful and the patient was discharged without any complication, she was advised to be on regular follow-up to assess valve gradients, paravalvular leaks and to monitor the disease progression. The presented case sheds light on the rare cardiac manifestation of alkaptonuria. In the absence of definitive pre-operative diagnosis, intraoperative findings played a pivotal role in guiding the surgical approach and choice of prosthetic valve. The decision to use a mechanical valve was influenced by the potential risks associated with bioprosthetic valves in the setting of ochronosis. Ongoing follow-up and monitoring are essential to assess the durability of the chosen prosthetic valve and to manage any long-term consequences of the underlying metabolic condition.
主动脉瓣狭窄与黑色主动脉瓣的罕见鉴别诊断:病例报告
心脏钙化症是一种罕见的常染色体隐性遗传疾病,表现为钙化的心脏瓣膜和动脉粥样硬化斑块的黑色色素沉着。我们报告了在一位患有退行性钙化性主动脉瓣狭窄的老太太身上发现黑色主动脉瓣的术中困境。一位 60 岁的女士因主动脉瓣严重狭窄而选择入院接受生物人工瓣膜置换术。她有头痛和头晕症状,主动脉瓣压力梯度为113/17mmhg。术中发现,她的主动脉内膜色素沉着并延伸至瓣膜瓣叶,因此被诊断为心脏chronosis,并接受了机械人工瓣膜置换术。术后对她进行了评估,诊断她患有碱蛋白尿。虽然手术很顺利,患者也顺利出院,没有出现任何并发症,但医生建议她定期随访,以评估瓣膜梯度、瓣膜旁漏并监测疾病进展。本病例揭示了碱通尿症罕见的心脏表现。在术前没有明确诊断的情况下,术中发现对手术方法和人工瓣膜的选择起到了关键性的指导作用。使用机械瓣的决定受到了生物人工瓣膜在chronosis情况下的潜在风险的影响。持续的随访和监测对于评估所选人工瓣膜的耐用性以及处理潜在代谢疾病的长期后果至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信