Redo Mechanical Aortic Valve Replacement after Leaflet Immobility and Severe Transvalvular Gradient in a Longstanding Prosthesis: A Case Report

This article reports a case of a 46-year-old male with a history of mechanical aortic valve replacement for chronic rheumatic heart disease. After 20 years, he presented with progressive breathlessness. Transthoracic and transesophageal echocardiography revealed one prosthetic leaflet’s severe transvalvular gradient and immobility. Redo aortic valve replacement (AVR) was performed using a femoro-femoral cardiopulmonary bypass approach to minimize the risk of cardiac avulsion. Intraoperatively, dense fibrous ingrowth around the prosthesis and leaflet dysfunction were confirmed. The patient underwent a successful redo of AVR with a mechanical valve. This case report highlights the importance of long-term surveillance in mechanical valve patients and the technical strategies that can minimize surgical risk during reoperation.