Pan-valvular heart disease in a dialysis patient with progressive jaundice: case report.

Background: Pan-valvular heart disease involving both native and prosthetic valves is rare and challenging to manage, especially in frail patients with limited treatment options. Case summary: A 74-year-old woman on dialysis with prior tricuspid and pulmonary bioprosthetic valve replacements presented with abdominal pain, diarrhoea, dyspnoea, and progressive jaundice. Echocardiography revealed severe aortic stenosis (AS) with pulmonary and tricuspid bioprosthetic valve dysfunction. Right heart catheterization confirmed significant pressure gradients and low cardiac index. Due to financial constraints and the high surgical risk, transcatheter valve-in-valve procedures and surgical treatment were not pursued. Instead, balloon valvuloplasty was performed on all three valves, resulting in transient haemodynamic improvement and bilirubin reduction. The patient later died from complications. Discussion: This case illustrates the balloon valvuloplasty as a palliative option in pan-valvular heart disease when definitive therapies are inaccessible. Such cases highlight a need for individualized, multidisciplinary care.