Acute heart failure caused by mechanical valve thrombosis in patient with dialysis following aortic and mitral valve replacement： A case report

Abstract

A 63‒year‒old woman started hemodialysis at 50 years of age due to diabetic nephropathy. Five years prior to this, she underwent aortic and mitral valve replacement using mechanical valves for aortic valve stenosis and mitral valve regurgitation, and coronary artery bypass grafting for angina. Following the surgery, anticoagulant therapy with warfarin was initiated； however, adjustments were difficult. Subsequently, the patient was admitted to our hospital with dyspnea caused by bilateral pleural effusion. The day after admission, an echocardiogram did not reveal any impairment in left ventricular wall motion or abnormalities of the aortic prosthetic valve, but moderate stenosis of the mitral prosthetic valve was noted. On the fourth day of hospitalization, the patient developed acute heart failure. Suspecting prosthetic valve dysfunction, mitral valve replacement was performed the following day, which resulted in improvement of heart failure. On its extraction, a thrombotic mechanical valve was identified. Hemodialysis patients present with a high risk of bleeding, making anticoagulation therapy management difficult. However, strict management is essential in cases involving prosthetic valve replacement. Prompt initial management is required when prosthetic valve dysfunction is suspected.