Case Report: Leaflet Thrombosis After Transcatheter Aortic Valve Replacement With Worsening Heart Failure—A Successful Resolution Using Non-vitamin K Antagonist Oral Anti-coagulant

Figure 1. (A) Echocardiogram showing a baseline trans-aortic valve mean pressure gradient of 15 mmHg 1 day after trans-aortic valve replacement (TAVR). (B) One year later, the patient developed a worsening heart failure, new onset of atrial fibrillation, and an increase of echocardiography-derived mean trans-aortic valve pressure gradient of 48 mmHg. (C) After 3-month treatment with non-vitamin K antagonist oral anti-coagulant, echocardiogram showing a mean trans-aortic valve pressure gradient of 17 mmHg.

Figure 2. (A) Systolic phase, two-dimensional (2D), short-axis view showing a hypo-attenuated leaflet thickening (HALT) suggestive of thrombus involving the base of leaflets (red arrows). (B) Systolic phase, 2D, short-axis view showing the resolution of HALT after 3-month of anti-coagulant therapy. (C) Diastolic, 2-D, short-axis view showing HALT suggestive of thrombus involving the base of leaflets (red arrows). (D) Diastolic phase, 2D, short-axis view showing resolution of HALT after 3-month of anti-coagulant therapy. (E) Systolic phase, 2D, long-axis view showing HALT suggestive of thrombus involving the base of leaflets (red arrows) and reduced systolic leaflet motion. (F) Systolic phase, 2D, long-axis view showing resolution of HALT and resumed normal systolic leaflet motion after 3-month of anti-coagulant therapy. (G) Diastolic phase, 2D, long-axis view showing HALT suggestive of thrombus involving the base of leaflets (red arrows). (H) Diastolic phase, 2D, long-axis view showing the resolution of HALT after 3-month of anti-coagulant therapy. RC, right coronary cuspid; LC, left coronary cuspid; NC, non-coronary cuspid.