Rheumatic Heart Disease with Quadrivalvular Stenosis: A Case Report and Review of Literature

Multivalvular heart disease (MVD), particularly of rheumatic nature, continues to be a widespread condition in developing countries such as Morocco, despite implemented preventive measures. The intricate hemodynamic interactions between coexisting valve lesions may influence the clinical expression of each individual lesion. It makes diagnosis difficult and management often at the discretion of the physician given the lack of specific guidelines to assist in strategy. In the available literature, rheumatic quadrivalvular stenosis is exceptional. Here we describe a very rare case of rheumatic involvement of all four heart valves discovered in a 34-year-old woman with a history of untreated recurrent tonsillitis and joint pain in childhood, who presented with progressively worsening dyspnea and fatigue. Transthoracic echocardiography revealed severe left valves stenosis in addition to severe tricuspid and mild pulmonary stenosis, with evidence of congestive heart failure. Our case highlights the diagnostic difficulties encountered in the context of a developing country with limited access to primary care and treatment options.