2022 Volume 86 Issue 6 Pages 1023-
The prevalence of mitral bioprosthetic valve thrombosis (BPVT) was recently reported as 6.2–12.7%.1 We present a case of mitral BPVT that occurred 9 months after surgery, in which cardiac computed tomography (CCT) showed efficacy of diagnostic and therapeutic evaluation.
The patient was an 81-year-old man who had undergone plastic surgery for mitral valve prolapse 13 years before. In addition, 12 years after that surgery, he underwent bioprosthetic valve replacement due to severe mitral stenosis (MS) and received warfarin for 3 months postoperatively. At 9 months postoperatively, he was hospitalized for acute heart failure with severe MS. He was in sinus rhythm, and atrial fibrillation was not documented. Transthoracic echocardiography (TTE) showed >50% increase in the transvalvular gradient and abnormal cusp mobility, suggesting BPVT1 (Figure A1,A2). Transesophageal echocardiography was necessary for further investigation but could not be performed due to symptoms. Therefore, CCT was performed, which showed hypoattenuated leaflet thickening at the base of the cusps and abnormal cusp mobility (Figure A3; Supplementary Movie 1). In addition, a large left atrial (LA) thrombus, which had not been detected by TTE, was connected to the prosthetic valve (Figure A4). Surgery or fibrinolysis was recommended, but he refused both because of advanced age and high bleeding risk. We had no choice but conservative treatment with anticoagulation using intravenous heparin. After 2 weeks, his circulatory condition was strikingly improved, and TTE showed a decrease in the transvalvular gradient and improved cusp mobility (Figure B1,B2). He was discharged with oral warfarin after 2 months in total. The CCT at discharge showed marked improvement in the mitral valve findings and disappearance of the LA thrombus (Figure B3,B4; Supplementary Movie 2).
(Upper) On admission, (Lower) at discharge. (A1,B1) Transthoracic echocardiography (color Doppler) in parasternal longitudinal view, (A2,B2) continuous-wave Doppler, (A3,B3) cardiac computed tomography (CCT) short axis of mitral valve, (A4,B4) longitudinal CCT. Pink arrowhead shows thrombus, and blue arrows indicate mitral cusps. LA, left atrium; LV, left ventricle; mPG, mean pressure gradient.
Authors declare no conflicts of interest. K.N. is a member of Circulation Journal’s Editorial Team.
Supplementary Movie 1. CCT on admission.
Supplementary Movie 2. CCT at discharge.
Please find supplementary file(s);
http://dx.doi.org/10.1253/circj.CJ-21-1009
