Secondary valvular insufficiency after valvular repair

1. Patient presentation

• A now 34-year-old male patient with a history of several years of intravenous drug abuse was first admitted to hospital 2 years ago because of dyspnea during exercise and chronic fatigue.
• His C-reactive protein level and white-blood cell count were elevated.
• Due to the suspicion of aortic valve endocarditis at echocardiography, CT angiography of the entire aorta was performed to assess the aortic valve and investigate possible systemic complications (Figure 1).
• CT angiography confirmed the aortic valve endocarditis and the patient was treated with a mechanical aortic valve implanted by open surgery.
• Owing to recurrence of the endocarditis, a secondary valvular repair with a bioprosthesis was performed one year later (images not shown).
• The patient has been recently re-admitted to the Chest Pain Unit because of rapidly progressing dyspnea during exercise.
• Echocardiography confirmed an aortic vitium combining relevant regurgitation and stenosis.
• Additionally, CT angiography was performed to visualize/rule out paravalvular changes and systemic complications (Figure 2).