What question did this study set out to answer?

To discuss the discovery of a thrombus on a bioprosthetic mitral valve during LVAD implantation and its implications.

January 6, 2026

Intraoperative Discovery of Bioprosthetic Mitral Valve Thrombus on TEE During HeartMate 3 Implantation: Implications for Anesthetic Management and Surgical Planning

JHJenny HuangScripps Health LSLida ShayganSouthwestern University

Key Points

To discuss the discovery of a thrombus on a bioprosthetic mitral valve during LVAD implantation and its implications.
Case report involving a 73-year-old female with history of chemotherapy-induced cardiomyopathy and mitral regurgitation.
Use of transthoracic echocardiogram preoperatively and transesophageal echocardiography intraoperatively to assess mitral valve status.
Concurrent mitral valve replacement during left ventricular assist device implantation.
Identification of a 2 cm × 1.2 cm thrombus using intraoperative transesophageal echocardiography.
Post-operative transesophageal echocardiography showed improvement in mean mitral gradient from 7 mmHg to 3 mmHg.
No thromboembolic events were observed following the procedure, and the patient was discharged in stable condition.

Abstract

We present the case of a 73-year-old female with chemotherapy-induced cardiomyopathy, severe mitral regurgitation status post bioprosthetic mitral valve (MV) replacement one year prior, and atrial fibrillation, admitted for evaluation for left ventricular assist device (LVAD) implantation. While her preoperative transthoracic echocardiogram (TTE) did not reveal a discrete mass, it showed a mean mitral gradient of 7 mmHg; intraoperative transesophageal echocardiography (TEE) identified a 2 cm × 1.2 cm thrombus on the bioprosthetic MV. Given these findings, the surgical team decided to replace the mitral valve concurrently with LVAD implantation. Although this approach is not routine, the goal was to improve her quality of life and reduce postoperative complications. Post-procedure TEE showed an improved MV mean gradient of 3 mmHg with no evidence of paravalvular leak. The patient was subsequently discharged home in stable condition without any thromboembolic events. This case highlights the challenges of managing complex valvular pathology in patients undergoing LVAD placement.

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