Prosthetic heart valve thrombosis - a headache for the heart team: A case report

Introduction. Prosthetic valve thrombosis is usually a subacute or chronic condition, although it may also present with a fresh thrombus. It occurs in two forms: obstructive and non-obstructive thrombosis. Case Report. We present a case of a female patient who underwent mitral valve replacement with mechanical prosthesis due to severe mitral stenosis. The postoperative course was uneventful and the patient was discharged on vitamin K antagonist therapy with international normalized ratio target 3.0. Five months later, the patient was admitted with severe shortness of breath and signs of acute heart failure. International normalized ratio at that moment was 2.3. Transthoracic echocardiography indicated severely raised gradient across the prosthetic valve and mechanical valve malfunction was suspected. Cinefluoroscopy showed that one of the prosthetic valve leaflets was completely immobile. Transesophageal echocardiography definitely confirmed thrombosis of the prosthetic valve with large multiple thrombi that completely fixed one leaflet in closed position, and partially limited the motion amplitude of the other leaflet. There were thrombi floating between the left ventricle and left atrium. Thrombectomy of the prosthetic valve was performed, which was sufficient for the complete restoration of the mechanical valve function. The vitamin K antagonist dosage was carefully up-titrated in order to reach and maintain the target international normalized ratio of 3.0. Conclusion. Prosthetic valve thrombosis is a serious and life-threatening condition that requires urgent management. Coordination and cooperation of the whole heart team is necessary for optimal choice of treatment, which primarily includes surgery or fibrinolysis.