Thrombus‐Induced Prosthetic Valve Dysfunction Demonstrating Hypo‐Attenuated Leaflet Thickening: A Case Report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Prosthetic valve dysfunction with hypo-attenuated leaflet thickening (n=1). Intervention: Redo aortic valve replacement. Primary outcome: Valve function and clinical stability.

Q: What does this research mean for the field?

Hypo-attenuated leaflet thickening (HALT) is a potentially underrecognized cause of late bioprosthetic valve dysfunction after surgical aortic valve replacement that requires multimodal imaging for diagnosis and can be effectively treated with timely intervention. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Takanori Kono; Kazuyoshi Takagi; Yusuke Shintani; H Mine; Eiki Tayama

doi:10.1002/ccr3.73518

September 1, 2026Clinical Case ReportsOpen Access

Thrombus‐Induced Prosthetic Valve Dysfunction Demonstrating Hypo‐Attenuated Leaflet Thickening: A Case Report

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Key result

Redo surgical aortic valve replacement successfully restored valve function in a patient with hypo-attenuated leaflet thickening and confirmed thrombotic leaflets, with no recurrence at 3 years.

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Key Points

To describe the multimodal imaging features, intraoperative findings, and clinical management of late bioprosthetic valve dysfunction linked to hypo-attenuated leaflet thickening.
Evaluated an 81-year-old man who developed bioprosthetic valve dysfunction three years following surgical aortic valve replacement with a 25-mm INSPIRIS RESILIA valve.
Conducted multimodal diagnostic imaging using transesophageal echocardiography and electrocardiogram-gated computed tomography prior to redo surgical aortic valve replacement.
Electrocardiogram-gated computed tomography identified hypo-attenuated leaflet thickening across all three bioprosthetic valve leaflets, which was surgically confirmed as macroscopic leaflet thrombosis.
Redo aortic valve replacement successfully restored hemodynamics, with postoperative echocardiography showing an ejection fraction of 65%, peak velocity of 1.9 m/s, peak pressure gradient of 14.4 mmHg, mean pressure gradient of 7.0 mmHg, and aortic valve area of 2.42 cm2.
At 3-year follow-up after reoperation, the patient remained clinically stable with no evidence of recurrent prosthetic valve dysfunction, thromboembolic events, or structural deterioration.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

An 81-year-old man who developed prosthetic valve dysfunction and hypo-attenuated leaflet thickening after surgical aortic valve replacement, followed for 3 years after redo surgery.

I

Intervention

Redo aortic valve replacement

O

Outcome

Identification of hypo-attenuated leaflet thickening (HALT) on preoperative CT and intraoperative confirmation of thrombotic valves

Hypo-attenuated leaflet thickening (HALT) after surgical aortic valve replacement can represent an active thrombotic process, highlighting the potential need for careful assessment and possible anticoagulation.

Limitations

Describes coexistence rather than proving causality between HALT and thrombotic leaflet changes
Single case report limits generalizability
Describes coexistence rather than proving causality
Single case report

Implication

May prompt consideration of HALT in late bioprosthetic dysfunction; leaves open need for prospective incidence and management data.

Abstract

Hypo-attenuated leaflet thickening (HALT) is an important and potentially underrecognized cause of late bioprosthetic valve dysfunction after surgical AVR. Multimodal imaging, including echocardiography and electrocardiogram-gated computed tomography, is essential for diagnosis, and timely surgical or medical intervention can effectively restore valve function and improve clinical outcomes.

Discussion

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Cite This Study

Kono et al. (2026) conducted a case report in Prosthetic valve dysfunction with hypo-attenuated leaflet thickening (n=1). Redo aortic valve replacement was evaluated on Valve function and clinical stability. Redo surgical aortic valve replacement successfully restored valve function in a patient with hypo-attenuated leaflet thickening and confirmed thrombotic leaflets, with no recurrence at 3 years.

synapsesocial.com/papers/6aa7afef79e9260bc85aacbc https://doi.org/10.1002/ccr3.73518

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Thrombus‐Induced Prosthetic Valve Dysfunction Demonstrating Hypo‐Attenuated Leaflet Thickening: A Case Report

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Thrombus‐Induced Prosthetic Valve Dysfunction Demonstrating Hypo‐Attenuated Leaflet Thickening: A Case Report

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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