Key result
Bioprosthetic replacement resolves recurrent embolic strokes in imaging-negative mechanical aortic valve thrombosis.
Why the study?
Recurrent embolic strokes without an identifiable source in patients with mechanical heart valves pose a significant diagnostic challenge.
Case Report (n=1)
No
This case highlights that small, nonobstructive mechanical valve thrombi can evade standard noninvasive imaging, and multidisciplinary evaluation for redo surgery should be considered in patients with unexplained recurrent embolic strokes.
May support considering redo surgery in refractory embolic strokes with mechanical valves; leaves open need for prospective data.
BACKGROUND: Recurrent embolic strokes without an identifiable source in patients with mechanical heart valves pose a significant diagnostic challenge. CASE SUMMARY: A 59-year-old woman with a mechanical aortic valve experienced recurrent embolic strokes, the first nearly 7 years after implantation during subtherapeutic anticoagulation. Repeated neurologic and cardiac imaging, thrombophilia screening, and prolonged rhythm monitoring failed to identify a definitive embolic source. Fluoroscopy and computed tomography showed discrete leaflet opening restriction. Multifocal infarctions raised clinical suspicion for mechanical valve thrombosis, prompting surgical exploration that confirmed diagnosis. The valve was replaced with a bioprosthesis, and left atrial appendage occlusion was performed. The patient remained event-free at 8-month follow-up. DISCUSSION: Mechanical valve thrombosis is rare and often undetectable. This case highlights the diagnostic dilemma and importance of multidisciplinary team evaluation. TAKE-HOME MESSAGE: Recurrent embolic strokes in mechanical valve patients with inconclusive testing should prompt multidisciplinary evaluation and consideration of valve replacement.
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Eriksen et al. (2025) conducted a case report in Recurrent embolic strokes in mechanical aortic valve (n=1). Surgical valve replacement with bioprosthesis and left atrial appendage occlusion was evaluated on Recurrence of thromboembolic events. Surgical replacement of a mechanical aortic valve with a bioprosthesis eliminated recurrent embolic strokes in a patient with imaging-negative nonobstructive valve thrombosis.
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