Rapid progression of mitral and aortic stenosis in a patient with secondary hyperparathyroidism

A 68 year old woman with chronic renal failure on long-term haemodialysis presented with progressive dyspnoea. Serial echocardiography showed a rapid reduction in mitral valve area from 2.18 to 0.92 cm2 over 18 months. In addition, the previously non-stenotic aortic valve was found to be severely stenotic with a valve area of 1.05 cm2. Cardiac catheterisation confirmed these findings. The patient had undergone subtotal parathyroidectomy more than 10 years before but had chemical and clinical evidence consistent with recurrent hyperparathyroidism. The patient underwent successful mitral and aortic valve replacement with relief of symptoms. Rapid progression of both aortic and mitral valve stenosis in the presence of secondary hyperparathyroidism is a rare finding.