Aortic Valve Insufficiency in an Elderly Male

DESCRIPTION A male in his late sixties came to the department of medicine with chief presenting complaints of acute shortness of breath, swollen legs and feet, and fatigue seeking medical attention for 1 month, aggravating on exertion and relieving at rest. It was revealed as a part of history that the patient had undergone aortic valve replacement (AVR) in 2016 and was a known case of diabetes mellitus. On systemic examination, the patient was subjected to echocardiography, and a provisional diagnosis of aortic valve insufficiency was kept as echocardiography confirmed the significant valvular leak, prompting an aortogram shown in Figure 1. The digital subtraction angiogram revealed a paravalvular leak evident in the aorta angiogram as shown in Figure 2 and leaflets of the aortic valve in x-ray shown in Figure 3 and transesophageal echocardiogram, indicating AVR. while contrast extravasation suggested the paravalvular leak shown in Figure 4. The patient was reportedly well a few days prior and had no history of hypertension, tuberculosis, bronchial asthma, fever, cough, or gastrointestinal symptoms. The prescribed medications included oral hypoglycemic and antiplatelet drugs since the patient had a previous cardiac interventional procedure in 2016 and antiepileptic drugs as he had a previous history of right temporal intraparenchymal bleed. Following consultation with cardiovascular and thoracic surgery (CVTS), the patient’s hemodynamic and vital parameters improved during the hospital stay. The discharge plan included the continuation of previous medications.Figure 1: AortogramFigure 2: Contrast extravasation suggestive of paravalvular leakFigure 3: X-ray demonstrating leaflets of the aortic valveFigure 4: Contrast extravasation suggestive of paravalvular leakAortic valve leakage, also referred to as aortic regurgitation, occurs when the aortic valve of the heart refuses to seal correctly, allowing blood to overflow into the left ventricle.[1] This condition can be caused by congenital defects, infections, or degeneration. It may cause symptoms such as shortness of breath and fatigue over time.[2] To restore adequate cardiac output and avoid problems, serious cases may necessitate surgical intervention, such as AVR. Individuals with aortic valve leakage require regular monitoring and medical care. This case posed a unique diagnostic challenge, emphasizing the importance of thorough assessment and collaboration with specialized services for comprehensive management.[3] LEARNING POINTS/TAKE HOME MESSAGES (2–3 BULLET POINTS) For the precise diagnosis of aortic valve insufficiency digital subtraction angiography followed by transechocardiography and aorto angiogram is preferred to determine the leakage of an aortic valve and is the method of choice The management of the patient is done with pharmacological and surgical intravascular intervention, but it may vary based on etiology. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.