2021 Volume 24 Issue 6 Pages 801-806
A stuck aortic valve is a fatal disease. Since it causes acute heart failure and cardiogenic shock, it usually requires surgical intervention. A 78-year-old man with a history of aortic valve replacement presented to the emergency department with acute onset of shortness of breath and chest pain. He presented with pulmonary edema and complete left bundle branch block. Echocardiography showed aortic valve stenosis (MaxV=4.23 m/s). We diagnosed acute heart failure and performed coronary angiography and cinefluoroscopy. Although his coronary artery was normal, cinefluoroscopy showed impaired motion of one of the leaflets of the mechanical aortic valve. Because of low PT-INR, we guessed it was caused by thrombosis. As his condition was stable at rest, we chose fibrinolysis as the first line of treatment, and started urokinase (120,000 units over a 12 h period) +heparin (10,000units per day). On the 7th day of hospitalization, we repeated cinefluoroscopy and confirmed the total restoration of leaflet motion. In conclusion, if the patient’s condition is stable, as the case may be, it is worth trying fibrinolysis instead of surgical intervention.
