Mechanical aortic valve replacement in a 24-year-old female with recurrent self-harm resulted in fatal prosthetic valve thrombosis over six years later due to non-adherence to oral anticoagulation.
Case Report (n=1)
This case highlights the critical challenges of managing severe psychiatric patients requiring mechanical valve prostheses, suggesting bioprosthetic valves may be preferable when long-term anticoagulation adherence is a major concern.
Background and Clinical Significance: We report an exceptionally rare case of mechanical aortic valve replacement necessitated by self-inflicted needle penetration with aortic valve and left ventricular involvement in a patient with recurrent self-harm behavior. Case Presentation: A 24-year-old female with post-traumatic stress disorder and emotionally unstable personality disorder, borderline type, presented with dyspnea two weeks after self-inserting multiple needles into her thorax. Computed tomography revealed a needle lodged in the aortic root and an intramyocardial needle with hemorrhagic pericardial effusion. Emergency sternotomy revealed inflammatory destruction of the right coronary aortic cusp with complete perforation. Following failed reconstruction attempts, mechanical aortic valve replacement was performed. The patient survived the immediate postoperative period but demonstrated recurrent non-adherence to oral anticoagulation, including multiple episodes of over- and under-anticoagulation. More than six years after surgery, she presented with cardiogenic shock due to prosthetic valve thrombosis after discontinuing warfarin for two weeks. Despite venoarterial ECMO and fibrinolytic therapy, she died from refractory left ventricular failure. Conclusions: This case highlights critical challenges in managing patients with severe psychiatric disorders requiring mechanical valve prostheses and suggests that bioprosthetic valves may warrant careful consideration in patients with major concerns regarding long-term anticoagulation adherence.
Breitwieser et al. (Thu,) conducted a case report in Self-inflicted cardiac needle penetration requiring mechanical aortic valve replacement (n=1). Mechanical aortic valve replacement was evaluated on Fatal long-term outcome (cardiogenic shock due to prosthetic valve thrombosis). Mechanical aortic valve replacement in a 24-year-old female with recurrent self-harm resulted in fatal prosthetic valve thrombosis over six years later due to non-adherence to oral anticoagulation.