Why the study?
Prosthetic valve thrombosis is most common in the mitral position, and this report describes a unique case of mitral PVT that physical exam and fluoroscopy would have missed.
Cardiac CT can identify prosthetic valve thrombosis even when fluoroscopic disc mobility appears normal.
Alerts to PVT missed by fluoroscopy in mitral prostheses; leaves open optimal imaging algorithms for future validation.
/background The incidence of prosthetic valve thrombosis (PVT) varies from 0.1% to 6% and is most common in the mitral position [1] . Transesophageal echocardiography (TEE), cardiac computed tomography (CT), and fluoroscopy are modalities used in the diagnostic algorithm. This is a unique case of mitral valve PVT that physical exam and fluoroscopy would have missed. Case summary A 67-year-old female presented with acute on chronic dyspnea. She underwent a transthoracic echocardiography (TTE) showing a mitral gradient of 10 mmHg at a heart rate of 88 beats per minute. A cardiac CT showed normal mechanical mitral disc motion with a 15 × 0.6 × 6 mm thrombus. Tissue plasminogen activator (tPA) was initiated, but her course was complicated by a hemorrhagic stroke. Discussion Cardiac CT can confirm diagnosis, assess ejection fraction and coronary anatomy without additional tests. Take home messages Cardiac CT can differentiate thrombus from pannus. Normal fluoroscopic disc mobility does not exclude a thrombus.
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Sankar et al. (2026) studied this question.
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