Key result
Cardiac CT detects prosthetic valve leaflet thrombosis causing embolic ACS when TEE is inconclusive.
Why the study?
Embolic thrombi from cardiac structures such as prosthetic valves represent a rare and underrecognized etiology of acute coronary syndrome.
Case Report (n=1)
This case highlights prosthetic valve leaflet thrombosis as an underrecognized cause of embolic acute coronary syndrome and demonstrates the superior diagnostic value of cardiac computed tomography over transesophageal echocardiography.
May support cardiac CT when TEE is inconclusive for prosthetic valve thrombosis in embolic ACS; hypothesis-generating pending prospective data.
BACKGROUND: Acute coronary syndrome (ACS) is most often caused by plaque rupture, but embolic thrombi from cardiac structures such as prosthetic valves represent a rare and underrecognized etiology. CASE SUMMARY: An 82-year-old female with a prior transcatheter aortic valve replacement presents with non-ST-elevation myocardial infarction. Coronary angiography revealed a thrombus extending from the distal left main into the left circumflex artery, successfully treated with aspiration thrombectomy and angioplasty. Transesophageal echocardiography showed no thrombus, but cardiac CT revealed thrombi on all 3 prosthetic valve cusps. She was started on long-term anticoagulation. DISCUSSION: This case illustrates prosthetic valve leaflet thrombosis as an unusual cause of embolic ACS. It highlights the limitations of transesophageal echocardiography in detecting leaflet thrombus and the superior diagnostic value of cardiac computed tomography. TAKE-HOME MESSAGES: Clinicians should consider valve thrombosis in embolic ACS and recognize cardiac CT as the preferred imaging modality. Further studies are needed to guide anticoagulation strategy.
No takes yet. Share an insight, caveat, or question.
Love et al. (2025) conducted a case report in Non-ST-segment elevation myocardial infarction secondary to embolic prosthetic valve thrombus (n=1). Aspiration thrombectomy, percutaneous transluminal angioplasty, and apixaban was evaluated. Prosthetic valve leaflet thrombosis is a rare but critical cause of embolic acute coronary syndrome that is accurately detected by cardiac computed tomography when transesophageal echocardiography is inconclusive.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: