Late Progressive Multivalvular Regurgitation After Heart Transplantation With Preserved Graft Function

Late clinical decline after heart transplantation is commonly attributed to rejection, cardiac allograft vasculopathy, or ventricular dysfunction. Progressive structural valvular disease is less frequently emphasized when graft systolic function is preserved.

A 22-year-old woman underwent orthotopic heart transplantation at age 13 for familial restrictive cardiomyopathy. Nearly 10 years later, she developed progressive exertional fatigue, reduced exercise tolerance, and dizziness despite preserved graft systolic function and no significant cardiac allograft vasculopathy. Serial imaging demonstrated severe mitral regurgitation, moderate to severe aortic regurgitation, and moderate to severe tricuspid regurgitation. She underwent redo sternotomy with bioprosthetic aortic and mitral valve replacement and tricuspid repair, with preserved ventricular function and clinical recovery at early follow-up.

This case highlights progressive multivalvular disease as an important valve-level cause of late clinical decline after heart transplantation.

Consider structural valvular disease in symptomatic long-term heart transplant recipients with preserved graft function.