With permission from the patient and his family to post, in order to help others, this is an extraordinary case of a 20-year-old who required a triple heart valve replacement operation.

He presented with gastrointestinal symptoms, fatigue, and weight loss. His work-up showed that he had a non-ischemic cardiomyopathy with an ejection fraction at one point as low as 20%. His condition was complicated by multi-valve endocarditis, likely a variant of non-bacterial thrombotic endocarditis (NTBE), secondary to inflammation. He did not have a history of COVID or recent vaccination.

He received excellent heart failure evaluation and care by Dr. David Allen at the St. Luke’s University Hospital, in Northampton County, Pennsylvania, and he sought a second opinion with Dr. Eduardo Rame, at the Jefferson University Hospital Heart Failure Center, in Center City, Philadelphia. The patient’s ejection fraction improved to 45-50%, but he still had severe aortic, mitral, and tricuspid valve regurgitation, requiring surgery.

After seeking several surgical opinions, the patient underwent aortic valve, mitral valve, and tricuspid valve replacement surgery at the Jefferson Einstein Montgomery Hospital, in East Norriton, Pennsylvania. He also had a heart muscle biopsy performed during surgery, special cultures, and genetic testing. He recovered well, now being discharged to home on post-operative day five.

Lots of lessons, but clearly the most important is how his Mom knew something was wrong with her son after months of nonspecific symptoms and weight loss. His Mom intervened and helped her son get the answers and excellent care that he needed, including a second and third opinion. On the physician side, doctors across multiple institutions and disciplines collaborated to help this young person avoid the need for a heart transplantation. Excellent outcome for what was a scary series of events for this young patient and his family.