Rheumatoid arthritis with severe aortic insufficiency and prolapse of the mitral valve

The valvular lesions caused by rheumatoid arthritis have been known for a long time. The valves may be affected by unspecific inflammatory changes or, specifically, by rheumatoid granulomas identical with subcutaneous nodules that lead to the malfunctioning of the aortic or the mitral valve. We present a patient affected by a classical seropositive rheumatoid arthritis accompanied by a severe aortic insufficiency and a prolapse of the mitral valve with rheumatoid involvement of the histologic granulomatous type, in whom both valves were replaced in two phases. The hemodynamic results were good for a period of time. Replacement of the valve by a prosthesis is the ideal treatment. There is no experience with treatment such a medication with immunosuppressive drugs.