Outcome and follow up
During follow-up, despite the treatment of heart failure with optimal medical therapy with foundational therapy and cardiac rehabilitation among others, his mitral and tricuspid regurgitations progressed to a worse severe grade, preventing an improvement in the symptoms reported by the patient, with a gradual increase in symptoms, which is why after holding a new medical meeting, it was considered that he was a candidate for mitral valve replacement and tricuspid valve plasty. Besides, a myocardial biopsy was performed during the surgery.
Although, in an interesting way, the myocardial biopsy revealed endocardial and subendocardial fibrosis with anisonucleosis of the cardiomyocytes, also with altered architecture from the myocardial fibres (Figure 3). Currently the patient is receiving optimal medical therapy for his heart failure and is undergoing cardiac rehabilitation.