Heart Failure with Reduced Ejection Fraction, Multiple-Valve Diseases, And Left Atrial Thrombus: A Case Report of Determining Whether to Do Intervention Strategies or Conservative Medical Therapies Only

Structural valvular heart disease (VHD) may be the cause of heart failure or may worsen the clinical status of patients with heart failure. Heart failure patients with VHD are at increased risk of events including sudden cardiac death. Before considering intervention (surgical or percutaneous) all patients should receive appropriate medical therapy. Numerous percutaneous and/or hybrid procedures have been introduced in the past few years and they are changing the management of VHD. In patients with heart failure and valvular heart disease, either primary or functional, the whole process of decision-making should be staged through a comprehensive evaluation of the risk-benefit ratio of different treatment strategies. In this case, a heart failure patient with multiple-valve diseases, LA thrombus, and dilated cardiomyopathy was referred to a faraway cardiac center to undergo intervention procedures. This is a case report of a 59-yo female who presented to the emergency ward, she was referred with the diagnosis of Chronic Heart Failure due to multiple-valve diseases, atrial fibrillation, hypo-potassium, and low blood pressure. From echocardiography, we found severe mitral stenosis, severe aortic stenosis, moderate aortic insufficiency, moderate tricuspid stenosis, severe tricuspid insufficiency, mild pulmonic insufficiency, with left atrial thrombus, and dilated cardiomyopathy. However, after the evaluation was made and had a discussion with the patient about the risk-benefit of intervention procedures, the patient chose to not undergoing the intervention procedures even though there was no contraindication found in the patients to the procedures that should be done to the patient.