Late thrombosis of a mitral bioprosthetic valve with associated massive left atrial thrombus
An 84-year-old man presented 5 years after bioprosthetic mitral valve replacement with three months of worsening dyspnea on exertion. A new mitral stenosis murmur was noted on physical examination, and an electrocardiogram revealed newly recognized atrial fibrillation. Severe mitral stenosis (mean g...
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| Format: | Article |
| Language: | English |
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BMC
2017-04-01
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| Series: | Echo Research and Practice |
| Online Access: | http://www.echorespract.com/content/4/1/I1.full |
| _version_ | 1811291673770065920 |
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| author | Preetham R Muskula Rigoberto Ramirez A Michael Borkon Michael L Main |
| author_facet | Preetham R Muskula Rigoberto Ramirez A Michael Borkon Michael L Main |
| author_sort | Preetham R Muskula |
| collection | DOAJ |
| description | An 84-year-old man presented 5 years after bioprosthetic mitral valve replacement with three months of worsening dyspnea on exertion. A new mitral stenosis murmur was noted on physical examination, and an electrocardiogram revealed newly recognized atrial fibrillation. Severe mitral stenosis (mean gradient = 13 mmHg) was confirmed by transthoracic echocardiography. Transesophageal echocardiography revealed markedly thickened mitral bioprosthetic leaflets with limited mobility, and a massive left atrial thrombus (>4 cm in diameter) (Fig. 1A, B, C, D and Videos 1, 2, 3 and 4). Intravenous heparin was initiated, and 5 days later, he was taken to the operating room for planned redo mitral valve replacement and left atrial thrombus extraction. Intraoperative transesophageal echocardiography revealed near-complete resolution of the bioprosthetic leaflet thickening, and a mean mitral gradient of only 3 mmHg (Fig. 2A, B, C and Videos 5, 6 and 7). The patient underwent resection of the massive left atrial thrombus (Fig. 2D) but did not require redo mitral valve replacement. He was initiated on heparin (and transitioned to warfarin) early in the post-operative period, with complete resolution of dyspnea on exertion at 3-month follow-up. Bioprosthetic valve thrombosis is increasingly recognized as a cause of early prosthetic valve dysfunction (1, 2). This case illustrates that bioprosthetic valve thrombosis may occur years after valve replacement; therefore, any deterioration in a patient’s clinical status (new-onset dyspnea, heart failure or atrial fibrillation) warrants a thorough evaluation of the bioprosthetic valve with transesophageal echocardiography. In this case, initiation of anticoagulation obviated the need for redo mitral valve replacement. |
| first_indexed | 2024-04-13T04:33:00Z |
| format | Article |
| id | doaj.art-205ea9545b0b410f887b890c298a6a55 |
| institution | Directory Open Access Journal |
| issn | 2055-0464 2055-0464 |
| language | English |
| last_indexed | 2024-04-13T04:33:00Z |
| publishDate | 2017-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Echo Research and Practice |
| spelling | doaj.art-205ea9545b0b410f887b890c298a6a552022-12-22T03:02:15ZengBMCEcho Research and Practice2055-04642055-04642017-04-0141I1I310.1530/ERP-17-0004Late thrombosis of a mitral bioprosthetic valve with associated massive left atrial thrombusPreetham R Muskula0Rigoberto Ramirez1A Michael Borkon2Michael L Main3Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USASaint Luke’s Mid America Heart Institute, Kansas City, Missouri, USASaint Luke’s Mid America Heart Institute, Kansas City, Missouri, USASaint Luke’s Mid America Heart Institute, Kansas City, Missouri, USAAn 84-year-old man presented 5 years after bioprosthetic mitral valve replacement with three months of worsening dyspnea on exertion. A new mitral stenosis murmur was noted on physical examination, and an electrocardiogram revealed newly recognized atrial fibrillation. Severe mitral stenosis (mean gradient = 13 mmHg) was confirmed by transthoracic echocardiography. Transesophageal echocardiography revealed markedly thickened mitral bioprosthetic leaflets with limited mobility, and a massive left atrial thrombus (>4 cm in diameter) (Fig. 1A, B, C, D and Videos 1, 2, 3 and 4). Intravenous heparin was initiated, and 5 days later, he was taken to the operating room for planned redo mitral valve replacement and left atrial thrombus extraction. Intraoperative transesophageal echocardiography revealed near-complete resolution of the bioprosthetic leaflet thickening, and a mean mitral gradient of only 3 mmHg (Fig. 2A, B, C and Videos 5, 6 and 7). The patient underwent resection of the massive left atrial thrombus (Fig. 2D) but did not require redo mitral valve replacement. He was initiated on heparin (and transitioned to warfarin) early in the post-operative period, with complete resolution of dyspnea on exertion at 3-month follow-up. Bioprosthetic valve thrombosis is increasingly recognized as a cause of early prosthetic valve dysfunction (1, 2). This case illustrates that bioprosthetic valve thrombosis may occur years after valve replacement; therefore, any deterioration in a patient’s clinical status (new-onset dyspnea, heart failure or atrial fibrillation) warrants a thorough evaluation of the bioprosthetic valve with transesophageal echocardiography. In this case, initiation of anticoagulation obviated the need for redo mitral valve replacement.http://www.echorespract.com/content/4/1/I1.full |
| spellingShingle | Preetham R Muskula Rigoberto Ramirez A Michael Borkon Michael L Main Late thrombosis of a mitral bioprosthetic valve with associated massive left atrial thrombus Echo Research and Practice |
| title | Late thrombosis of a mitral bioprosthetic valve with associated massive left atrial thrombus |
| title_full | Late thrombosis of a mitral bioprosthetic valve with associated massive left atrial thrombus |
| title_fullStr | Late thrombosis of a mitral bioprosthetic valve with associated massive left atrial thrombus |
| title_full_unstemmed | Late thrombosis of a mitral bioprosthetic valve with associated massive left atrial thrombus |
| title_short | Late thrombosis of a mitral bioprosthetic valve with associated massive left atrial thrombus |
| title_sort | late thrombosis of a mitral bioprosthetic valve with associated massive left atrial thrombus |
| url | http://www.echorespract.com/content/4/1/I1.full |
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