A complex triple valve repair in a young rheumatic patient

We report a case of a 22-year-old Ethiopian female presenting with multiple rheumatic valve disease. She was admitted to hospital because of dyspnea at rest. She underwent open mitral commissurotomy associated with splitting of the postero-medial papillary muscle, aortic right-coronary-left coronary commissural resuspension with resection of fibrous tissue from the free-edge cusps and open tricuspid commissurotomy of all three commissures completed with chordal shortening of the anterior leaflet. The postoperative course was uneventful. The patient was asymptomatic without recurrence of symptoms at 2 months. Echocardiography confirmed the satisfactory outcome of the multiple repair with no residual insufficiency. Multiple repair is advisable for patients living in many areas of the Third World, where the safety of long-term anticoagulation cannot be assured.