Treatment of Acute M3 Thrombosis

BACKGROUND: The Edwards SAPIEN M3 transcatheter mitral valve replacement (TMVR) has demonstrated safety and efficacy in the treatment of symptomatic patients with mitral valve disease for whom commercially available surgical or transcatheter treatment options are deemed unsuitable. We present a case of acute M3 thrombosis due to oral anticoagulation nonadherence, complicated by cardiogenic shock, successfully treated with valve-in-valve intervention. CASE SUMMARY: A 58-year-old woman with recent M3 TMVR presented with cardiogenic shock, and was found to have prosthetic valve thrombosis with elevated gradients across the mitral valve and heavy clot burden causing severe mitral stenosis. After worsening hemodynamic parameters with thrombolytic therapy alone, emergent valve-in-valve TMVR was performed with successful implantation of a 29-mm Edwards SAPIEN S3 Ultra Resilia valve inside the Encircle M3 valve. DISCUSSION: We demonstrate the effective management of a rare but serious complication of TMVR with prosthetic valve thrombosis successfully treated with valve-in-valve reintervention. TAKE-HOME MESSAGES: Valve thrombosis remains a clinically significant complication in next-generation transcatheter mitral valve systems, emphasizing the need for vigilant anticoagulation management and early diagnostic consideration. For patients with high surgical risk who present with acute thrombosis, ad hoc valve-in-valve reintervention is an effective treatment option.