This 58-year-old patient on chronic hemodialysis for end-stage renal disease presented with acute systolic heart failure, metabolic acidosis, and hypotension. On ECHO his aortic valve area was 0.4 cm². The valve had a fixed opening and therefore the patient also had moderate-to-severe aortic insufficiency. He was stabilized and promptly taken to the operating room for surgical aortic valve replacement with a CryoLife On-X valve.
The choice of a mechanical valve was based on his young age, the fact that he was already on chronic anticoagulation, and the concern that a biological valve would deteriorate rapidly from the impact of hemodialysis.
This photograph shows the aortic valve specimen removed intact, revealing a donut of calcium and debris, along with a small fixed opening.
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