Obstructive thrombosis of mitral prosthesis — diagnostic trap during a pandemic

Prosthetic obstructive thrombosis, being a major emergency, requires the identification of symptoms of heart failure, which are crucial elements in the early diagnosis and initiation of prompt therapeutic management. Adequate clinical, preclinical and instrumental assessment is the key tactic, used both to confirm the diagnosis and to assess the severity of the general condition and the prognosis of survival of the patient with obstructive thrombosis of the valve prosthesis. Prosthetic heart valve thrombosis is a rare but serious complication. Surgery is the first-line therapy in symptomatic obstructive mechanical valve thrombosis, thrombolytic therapy has been used as an alternative to surgical treatment. In this case report we described a 63-year-old woman who had undergone mitral valve replacement operation 11 months ago, presenting to the guard room in an extremely serious general condition, in polyvisceral and polysystemic dysfunction syndrome (MODS). A thrombus was detected on the prosthetic mitral valve with high transmitral gradient by transthoracic echocardiography. Tissue plasminogen activator treatment was administered successfully. The gradient was improved on prosthetic mitral valve and embolic complications or bleeding were not occurred.