Bioprosthetic valve degeneration due to cholesterol deposition in a patient with normal lipid profile.

Hypercholesterolemia has been identified as a risk factor for bioprosthetic valvular degeneration, and it has been suggested that statin therapy reduces this risk. The case of a 77-year-old man with low levels of low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B who developed marked LDL-C crystal deposition and a severe foreign body giant cell reaction 21.5 years after aortic bioprosthetic replacement is reported. This observation confirms that cholesterol deposition contributes to bioprosthetic valve degeneration, but that this can occur even in patients with low levels of LDL-C. It suggests that the characteristics of the valve are more critical than the patient's level of LDL-C.