Coronary embolism due to probable clinical bioprosthetic aortic valve thrombosis: a case report

Abstract Background Coronary embolism is a relatively rare but important non-atherosclerotic cause of acute coronary syndrome, mainly caused by atrial fibrillation and mechanical heart valve thrombosis due to subtherapeutic anticoagulation. There have been increasing reports of bioprosthetic valve t...

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Main Authors: Roshan A Ananda, Zhihua Zhang
Format: Article
Language:English
Published: BMC 2023-06-01
Series:BMC Cardiovascular Disorders
Subjects:
Online Access:https://doi.org/10.1186/s12872-023-03359-9
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author Roshan A Ananda
Zhihua Zhang
author_facet Roshan A Ananda
Zhihua Zhang
author_sort Roshan A Ananda
collection DOAJ
description Abstract Background Coronary embolism is a relatively rare but important non-atherosclerotic cause of acute coronary syndrome, mainly caused by atrial fibrillation and mechanical heart valve thrombosis due to subtherapeutic anticoagulation. There have been increasing reports of bioprosthetic valve thrombosis (BPVT), but thromboembolic events are rare and mainly affect the cerebrovascular system. Coronary embolism is an extremely rare complication of BPVT. Case presentation A 64-year-old male presented with non-ST-Elevation myocardial infarction (NSTEMI) to an Australian regional health service. Three years ago, he had undergone Bentall procedure with bioprosthetic aortic valve replacement for severe aortic regurgitation and significant aortic root dilatation. Diagnostic coronary angiography revealed embolic occlusion of first diagonal branch in the absence of underlying atherosclerosis. Prior to NSTEMI presentation, the patient was clinically asymptomatic apart from the progressive increase in transaortic mean pressure gradient on transthoracic echocardiography which was first detected seven months after surgical aortic valve replacement. Transoesophageal echocardiography showed restrictions of the aortic leaflet opening but no evidence of mass or vegetation. After eight weeks of warfarin therapy, the raised aortic valve gradient returned to normal. Lifelong warfarin was prescribed, and patient remained clinically well at 39-month follow-up. Conclusion We experienced a case of coronary embolism in a patient with probable BPVT. Reversible bioprosthetic valve hemodynamic deterioration after anticoagulation strongly supports the diagnosis in the absence of histopathology. Early moderate-to-severe hemodynamic valve deterioration warrants further investigations, including cardiac computed tomography and sequential echocardiography, to investigate for probable BPVT and consideration of timely anticoagulation initiation to prevent thromboembolic events.
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spelling doaj.art-44d25dc8e6784c88a97126b6be37d95a2023-07-02T11:06:44ZengBMCBMC Cardiovascular Disorders1471-22612023-06-012311810.1186/s12872-023-03359-9Coronary embolism due to probable clinical bioprosthetic aortic valve thrombosis: a case reportRoshan A Ananda0Zhihua Zhang1Department of Cardiology, Mackay Base HospitalDepartment of Cardiology, Mackay Base HospitalAbstract Background Coronary embolism is a relatively rare but important non-atherosclerotic cause of acute coronary syndrome, mainly caused by atrial fibrillation and mechanical heart valve thrombosis due to subtherapeutic anticoagulation. There have been increasing reports of bioprosthetic valve thrombosis (BPVT), but thromboembolic events are rare and mainly affect the cerebrovascular system. Coronary embolism is an extremely rare complication of BPVT. Case presentation A 64-year-old male presented with non-ST-Elevation myocardial infarction (NSTEMI) to an Australian regional health service. Three years ago, he had undergone Bentall procedure with bioprosthetic aortic valve replacement for severe aortic regurgitation and significant aortic root dilatation. Diagnostic coronary angiography revealed embolic occlusion of first diagonal branch in the absence of underlying atherosclerosis. Prior to NSTEMI presentation, the patient was clinically asymptomatic apart from the progressive increase in transaortic mean pressure gradient on transthoracic echocardiography which was first detected seven months after surgical aortic valve replacement. Transoesophageal echocardiography showed restrictions of the aortic leaflet opening but no evidence of mass or vegetation. After eight weeks of warfarin therapy, the raised aortic valve gradient returned to normal. Lifelong warfarin was prescribed, and patient remained clinically well at 39-month follow-up. Conclusion We experienced a case of coronary embolism in a patient with probable BPVT. Reversible bioprosthetic valve hemodynamic deterioration after anticoagulation strongly supports the diagnosis in the absence of histopathology. Early moderate-to-severe hemodynamic valve deterioration warrants further investigations, including cardiac computed tomography and sequential echocardiography, to investigate for probable BPVT and consideration of timely anticoagulation initiation to prevent thromboembolic events.https://doi.org/10.1186/s12872-023-03359-9Coronary embolismBioprosthetic aortic valveSurgical aortic valve replacementBioprosthetic valve thrombosisAnticoagulationCase report
spellingShingle Roshan A Ananda
Zhihua Zhang
Coronary embolism due to probable clinical bioprosthetic aortic valve thrombosis: a case report
BMC Cardiovascular Disorders
Coronary embolism
Bioprosthetic aortic valve
Surgical aortic valve replacement
Bioprosthetic valve thrombosis
Anticoagulation
Case report
title Coronary embolism due to probable clinical bioprosthetic aortic valve thrombosis: a case report
title_full Coronary embolism due to probable clinical bioprosthetic aortic valve thrombosis: a case report
title_fullStr Coronary embolism due to probable clinical bioprosthetic aortic valve thrombosis: a case report
title_full_unstemmed Coronary embolism due to probable clinical bioprosthetic aortic valve thrombosis: a case report
title_short Coronary embolism due to probable clinical bioprosthetic aortic valve thrombosis: a case report
title_sort coronary embolism due to probable clinical bioprosthetic aortic valve thrombosis a case report
topic Coronary embolism
Bioprosthetic aortic valve
Surgical aortic valve replacement
Bioprosthetic valve thrombosis
Anticoagulation
Case report
url https://doi.org/10.1186/s12872-023-03359-9
work_keys_str_mv AT roshanaananda coronaryembolismduetoprobableclinicalbioprostheticaorticvalvethrombosisacasereport
AT zhihuazhang coronaryembolismduetoprobableclinicalbioprostheticaorticvalvethrombosisacasereport