In atrioventricular (AV) discordance, a morphologic tricuspid valve functioning as a systemic AV valve often becomes incompetent and needs to be replaced. However, mitral valve replacement concomitant with tricuspid valve replacement is unusual in the disease. Here, we report a case of successful double AV valve replacement long after functional biventricular repair in AV discordance. A 32-year-old man with AV discordance was admitted with orthopnea. He had undergone the Rastelli procedure at age 10 and removal of the deteriorated conduit valve at age 24. Preoperative examinations revealed not only tricuspid but also mitral regurgitation. Both deteriorated valves were replaced with mechanical valves. In AV discordance after Rastelli procedure, a non-valved conduit may accelerate mitral deterioration because pulmonary hypertension from tricuspid regurgitation increases the afterload of the pulmonary ventricle.

Many patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) complain of respiratory distress, chest pain, and arthralgia even after their recovery. We tried to give saibokuto to a 61-year-old man who has suffered from those symptoms as after effects of COVID-19 for more than 2 months. We report that after administration of saibokuto, almost all symptoms have disappeared within 3 weeks.