Obstructive Thrombosis of Transcatheter Pulmonary Valve-in-Valve Prosthesis

Figures

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  Figure 1. Transthoracic Echocardiogram Continuous Wave Doppler Across the Pulmonary Valve Imaging reveals a mean gradient of 6.1 mm Hg.

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  Figure 2. Transthoracic Echocardiogram Imaging uses color Doppler to highlight flow acceleration during systole, marked by the blue arrow. It also features a continuous wave (CW) Doppler analysis of a prosthetic pulmonary valve. The mean gradient across the valve, which is indicated by the green arrow, is measured at 17 mm Hg. CF = color flow; max = maximum; PG = pressure gradient; PV = pulmonary valve; PVA = pulmonary valve area; V = velocity, VTI = velocity time integral; 2D = 2-dimensional.

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  Figure 3. Short-Axis View of the Prosthetic Pulmonary Valve Imaging shows valve thrombosis involving the inferior-posterior leaflet. L = left; R = right.

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  Figure 4. Long-Axis View, Prosthetic Pulmonary Valve Imaging shows valve thrombosis involving the inferior-posterior leaflet. A = anterior; P = posterior; S = superior.

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  Figure 5. Computed Tomography Angiography of the Chest Imaging demonstrates significant enlargement of the central pulmonary arteries, consistent with chronic pulmonary valve disease. Additionally, a calcified subocclusive chronic thrombus is identified in the left lower lobe pulmonary artery. This finding, indicated by the blue and green arrows, highlights the location of the thrombus at the origin of the segmental arterial branches of the basilar segments of the left lower lobe.

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  Figure 6. Transthoracic Echocardiogram After 4 Weeks of Anticoagulation Imaging demonstrates a continuous-wave (CW) Doppler measurement of the mean gradient, indicated by the green arrow, of 5 mm Hg. Abbreviations as in Figure 2.

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  Figure 7. Nuclear Medicine Ventilation-Perfusion Scan Imaging shows perfusion images with mild inhomogeneity, indicating uneven distribution of blood flow in the lungs, but without any significant mismatched perfusion defects, which would suggest that areas of the lung are well ventilated. The single-breath ventilation image appears normal, and the washout phase is also normal, indicating effective clearance of air from the lungs without obstruction or retention. No evidence of pulmonary embolism is noted. I = inferior; LAO = left anterior oblique; LPO = left posterior oblique; LT = left; RAO = right anterior oblique; RPO = right posterior oblique; RT = right; other abbreviations as in Figures 3 and 4.