Rheumatic heart disease: how many interventions and complications can a patient overcome?

Introduction Rheumatic heart disease (RHD) is a serious, long-term consequence of acute rheumatic fever that is characterized by progressive evolution over the years. Recurrent inflammatory damage to the heart valves leads to cumulative dysfunction with significant rheumatic valvular involvement peaking between the second and fourth decades of life. Case presentation This article presents the case of a 71-year-old woman with a history of mitral and tricuspid valve replacements due to severe rheumatic mitral stenosis and tricuspid regurgitation who has experienced a complex medical journey. She was recently admitted for decompensated heart failure attributed to severe degenerative aortic valve stenosis. Her comorbidities included permanent atrial fibrillation, chronic kidney disease, chronic hepatitis C infection, gastritis and anemia. She also had a VVI cardiac pacemaker implanted for complete atrioventricular block. Given her high surgical risk, a comprehensive discussion within the Heart Team led to the decision for transcatheter aortic valve replacement (TAVI). Conclusion This case underscores the importance of a continuum of care for patients with RHD. It highlights the complexity of managing individuals with a long history of RHD, multiple comorbidities and numerous iatrogenic and prosthesis-related complications.