A Rare Case of Aortic Valve Thrombosis 12 Years Post-Bioprosthetic Implantation

BACKGROUND: Bioprosthetic valve thrombosis (BPVT) can occur after valve implantation, typically within the first 3 months. However, it can also develop after many years, as shown in this case. CASE SUMMARY: We report a 75-year-old male who developed progressive heart failure and cardiogenic shock 12 years after receiving a bioprosthetic aortic valve. Echocardiography revealed a thickened, immobile echo density on the valve, suspicious for BPVT, which was confirmed by cardiac computed tomography. The patient was treated with oral anticoagulants which successfully reduced the valve gradient. DISCUSSION: This case shows that, although uncommon, BPVT can occur late after valve implantation. Additional risk factors such as atrial fibrillation without adequate anticoagulation can contribute to late BPVT. Anticoagulation is the mainstay of treatment. This case highlights the importance of considering BPVT in long-term bioprosthetic valves because it has important therapeutic and prognostic consequences. TAKE-HOME MESSAGE: Bioprosthetic valve thrombosis 12 years after implantation is possible, especially in patients in a pro-coagulant state.