Cardiac Valvular Inflammatory Pseudotumor

Diseases of the heart valves cut across all age groups, race and geographic locations to form a significant cause of morbidity and mortality. These deformities may be congenital or acquired, as a result of developmental, post-inflammatory and degenerative changes. In our country, owing to high prevalence of rheumatic heart disease [1], the etiology in most valvular dysfunctions (stenosis and/or regurgitation) is attributed to rheumatic heart disease, unless proved otherwise. This is largely true in most instances, but there do exist occasions, where a "rheumatic "assumption is erroneous. We present a rare case of inflammatory pseudotumor, manifesting as a granulomatous valvulitis, producing chronic mitral and aortic regurgitation in a 62 years old lady.A 62-year-old woman presented to our Cardiovascular & Thoracic Center with complaints of breathlessness and palpitation. The dyspnea (grade II), present for the past eight years, had progressed in six months to grades III/IV. She had had past hospital admissions for similar complaints. A secundum atrial septal defect had been closed in the year 1990. She was advised valve replacement for rheumatic valvular heart disease. Routine hematological and biochemical investigations had been normal. Two-dimensional echocardiography showed severe mitral and moderate aortic, regurgitation. The pulmonary arterial pressure was 80 mm Hg. She was taken up for mitral and aortic valve replacements. The anterior mitral leaflet was thick and fleshy while the posterior leaflet was thin. There was no significant sub-valvular pathology. The anterior leaflet and the medial scallop of the posterior leaflet were excised and the valve was replaced by Carbomedics mechanical valve (27 mm). The right and non-coronary cusps of the aortic valve showed similar thickening. The cusps were excised and the valve replaced by a St. Jude's mechanical valve (19 mm). During surgery, there was inadvertent tear of the superior caval vein, which was sutured and