Bioprosthetic Aortic Valve Thrombosis and Literature Review
An 83-year-old gentleman with a history of 23-mm Hancock-II-bioprosthetic aortic valve (BAV) replacement ten-years prior presented with symptoms of dyspnea and lower extremity edema. During the preceding seven-years, he had been noted to have asymptomatic increased mean transvalvular gradients (MG;...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-08-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/9/8/252 |
| _version_ | 1827617876809351168 |
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| author | Milan Radovanovic Charles W. Nordstrom Richard D. Hanna |
| author_facet | Milan Radovanovic Charles W. Nordstrom Richard D. Hanna |
| author_sort | Milan Radovanovic |
| collection | DOAJ |
| description | An 83-year-old gentleman with a history of 23-mm Hancock-II-bioprosthetic aortic valve (BAV) replacement ten-years prior presented with symptoms of dyspnea and lower extremity edema. During the preceding seven-years, he had been noted to have asymptomatic increased mean transvalvular gradients (MG; 36–50 mmHg) felt to be due to either early bioprosthetic degeneration, pannus formation, or patient–prosthesis mismatch. An echocardiogram at the time of symptom development demonstrated significant flow acceleration through the aortic valve, mild regurgitation, and severely increased MG (48 mmHg) with prolonged acceleration time (AT, 140 msec). A trial of warfarin anticoagulation resulted in dramatic improvement after only 6 weeks with laminar flow through the AV, near-total resolution of regurgitation, and a decrease in MG to 14 mmHg and AT to 114 msec. These findings strongly suggest that BAV thrombosis was the predominant mechanism responsible for the longstanding high MG. Our case highlights that BAV thrombosis should be considered in the differential of elevated gradients regardless of the age of prosthesis, and that a trial of warfarin anticoagulation may be beneficial even if elevated gradients have been present for a prolonged period. Valvular gradients are often abnormal long before a formal diagnosis; however, these may reverse quickly with anticoagulation therapy. |
| first_indexed | 2024-03-09T09:55:39Z |
| format | Article |
| id | doaj.art-b23ef5d700dc4d30b7dde773329e8c8c |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-09T09:55:39Z |
| publishDate | 2022-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-b23ef5d700dc4d30b7dde773329e8c8c2023-12-01T23:49:38ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252022-08-019825210.3390/jcdd9080252Bioprosthetic Aortic Valve Thrombosis and Literature ReviewMilan Radovanovic0Charles W. Nordstrom1Richard D. Hanna2Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USAMayo Clinic Alix School of Medicine, Rochester, MN 55905, USAMayo Clinic Alix School of Medicine, Rochester, MN 55905, USAAn 83-year-old gentleman with a history of 23-mm Hancock-II-bioprosthetic aortic valve (BAV) replacement ten-years prior presented with symptoms of dyspnea and lower extremity edema. During the preceding seven-years, he had been noted to have asymptomatic increased mean transvalvular gradients (MG; 36–50 mmHg) felt to be due to either early bioprosthetic degeneration, pannus formation, or patient–prosthesis mismatch. An echocardiogram at the time of symptom development demonstrated significant flow acceleration through the aortic valve, mild regurgitation, and severely increased MG (48 mmHg) with prolonged acceleration time (AT, 140 msec). A trial of warfarin anticoagulation resulted in dramatic improvement after only 6 weeks with laminar flow through the AV, near-total resolution of regurgitation, and a decrease in MG to 14 mmHg and AT to 114 msec. These findings strongly suggest that BAV thrombosis was the predominant mechanism responsible for the longstanding high MG. Our case highlights that BAV thrombosis should be considered in the differential of elevated gradients regardless of the age of prosthesis, and that a trial of warfarin anticoagulation may be beneficial even if elevated gradients have been present for a prolonged period. Valvular gradients are often abnormal long before a formal diagnosis; however, these may reverse quickly with anticoagulation therapy.https://www.mdpi.com/2308-3425/9/8/252bioprosthetic aortic valvethrombosiselevated transvalvular gradients |
| spellingShingle | Milan Radovanovic Charles W. Nordstrom Richard D. Hanna Bioprosthetic Aortic Valve Thrombosis and Literature Review Journal of Cardiovascular Development and Disease bioprosthetic aortic valve thrombosis elevated transvalvular gradients |
| title | Bioprosthetic Aortic Valve Thrombosis and Literature Review |
| title_full | Bioprosthetic Aortic Valve Thrombosis and Literature Review |
| title_fullStr | Bioprosthetic Aortic Valve Thrombosis and Literature Review |
| title_full_unstemmed | Bioprosthetic Aortic Valve Thrombosis and Literature Review |
| title_short | Bioprosthetic Aortic Valve Thrombosis and Literature Review |
| title_sort | bioprosthetic aortic valve thrombosis and literature review |
| topic | bioprosthetic aortic valve thrombosis elevated transvalvular gradients |
| url | https://www.mdpi.com/2308-3425/9/8/252 |
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