Spontaneous late and near-complete dehiscence of a prosthetic aortic valve: an unusual complication without infectious or inflammatory components

Abstract Background Aortic valve replacement is one of the most common major cardiac surgeries worldwide, with various short- and long-term complications. Among these, prosthetic valve dehiscence, ranging from mild regurgitation to life-threatening severe paravalvular leaks, is one of the most catastrophic complications of prosthetic valves. Case presentation A hemodynamically stable 63-year-old patient with a history of two past cardiac surgeries due to aortic stenosis and aortic root aneurysm presented with dyspnea and coughing in the last 2 weeks. Fluoroscopy and transthoracic echocardiography revealed the aortic valve dehiscence after 40 years of the first surgery, and he underwent emergency redo surgery. A new mechanical valve replaced the aortic valve, and the aortic root remains intact. Although infectious and inflammatory conditions play an important role in late aortic valve dehiscence, in our patient, there was no evidence of either inflammation or infection. After surgery, patients recovered without any signs of complications. Conclusions This case highlights the complexity of diagnosing and managing late-onset prosthetic valve dehiscence. While often attributed to infection, chronic subclinical processes—such as progressive para-prosthetic leaks or annular degeneration—may silently progress and ultimately result in acute decompensation. Both infectious and noninfectious causes must be considered to ensure timely intervention and optimal outcomes.