Quadruple valve replacement in a patient with severe rheumatic heart disease

We present a patient with rheumatic heart disease involving all the heart valves. An intraoperative transoesophageal echocardiography confirmed severe mitral stenosis, severe aortic regurgitation, severe tricuspid regurgitation and stenosis, and severe pulmonary stenosis. The patient underwent successful quadruple valve replacement during a single operation at the Groote Schuur Hospital, Cape Town, South Africa. LEARNING POINTS: Rheumatic heart disease can affect all the heart valves including the pulmonary valve. Intraoperative transoesophageal echocardiography is key for diagnosis, monitoring and confirmation of successful surgical result during heart valve surgery. Combined surgical procedure of all four valves is possible though associated with long procedural time.