Late thrombosis of a mitral bioprosthetic valve with associated massive left atrial thrombus

Figures

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  Figure 1. (A) Mid-esophageal 2-chamber TEE image reveals a massive left atrial mural thrombus (yellow arrow) and markedly thickened bioprosthetic mitral leaflets (white arrow). (B) Mid-esophageal long-axis TEE image reveals a massive left atrial mural thrombus (yellow arrow) and markedly thickened bioprosthetic mitral leaflets (white arrow). (C) Off-axis TEE view of the left atrium reveals a massive left atrial thrombus (white arrow). (D) Three-dimensional en face view (left atrial perspective) of the stenotic bioprosthetic mitral valve. Note the left atrial mural thrombus (black arrow).

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  Figure 2. (A) Intraoperative mid-esophageal 2-chamber TEE image demonstrates thin and pliable bioprosthetic mitral leaflets (white arrow) after 5 days of intravenous heparin (compare to Fig. 1A and B). The left atrial thrombus remains (yellow arrow). (B) Intraoperative mid-esophageal TEE image after extraction of the left atrial thrombus (compare to Fig. 2A). The bioprosthetic mitral leaflets appear normal (white arrow). (C) Three-dimensional en face view (left atrial perspective). The mitral valve area is improved (compared to Fig. 1D), and the left atrial thrombus has been extracted. (D) Left atrial thrombus after resection.