Obstructive Mechanical Mitral Valve Thrombosis Complicated by Cardiogenic Shock With Absolute Contraindication to Thrombolysis: Surgical Management Strategy

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Obstructive mechanical mitral valve thrombosis complicated by cardiogenic shock (n=1). Intervention: Urgent surgical intervention.

Q: What does this research mean for the field?

Urgent surgical intervention effectively manages obstructive mechanical mitral valve thrombosis complicated by cardiogenic shock when thrombolysis is absolutely contraindicated. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Z. Bennoui; N. Annane

doi:10.69980/ajbr.v29i1s.9370

March 12, 2026African Journal of Biomedical ResearchOpen Access

Obstructive Mechanical Mitral Valve Thrombosis Complicated by Cardiogenic Shock With Absolute Contraindication to Thrombolysis: Surgical Management Strategy

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Key result

Urgent surgery serves as definitive therapy for obstructive mechanical mitral valve thrombosis in cardiogenic shock.

n=1

Why the study?

Prosthetic mechanical valve thrombosis is a rare, life-threatening complication with limited treatment options when thrombolysis is contraindicated.

Key Points

To describe the therapeutic decision-making and emergency surgical strategy for obstructive prosthetic mitral valve thrombosis presenting in cardiogenic shock with an absolute contraindication to fibrinolytic therapy.
Evaluated a 35-year-old female presenting with acute pulmonary edema, cardiogenic shock (systolic blood pressure 80 mm Hg), and subtherapeutic anticoagulation 6 years following 31-mm bileaflet mechanical mitral valve implantation.
Diagnosed prosthetic dysfunction using transthoracic and transesophageal echocardiography to differentiate thrombosis from pannus and quantify hemodynamic impairment.
Initiated pre-operative intensive care stabilization using intravenous furosemide, continuous positive airway pressure, dobutamine, and unfractionated heparin prior to multidisciplinary Heart Team consultation.
Transesophageal echocardiography identified obstructive partial thrombosis with restricted leaflet mobility, an elevated mean transprosthetic gradient of 24 mm Hg, and an estimated pulmonary artery systolic pressure of 50 mm Hg.
Laboratory testing confirmed subtherapeutic anticoagulation with an INR of 1.5, leukocytosis of 15,000/mm³, and hemoglobin of 10 g/dL.
Fibrinolysis was ruled out due to an intracranial hemorrhage occurring one month prior, establishing urgent surgical intervention as the definitive management option after initial hemodynamic stabilization.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 35-year-old woman with a mechanical mitral prosthesis who presented with acute pulmonary edema, cardiogenic shock, and an absolute contraindication to thrombolysis.

I

Intervention

Urgent surgical intervention after hemodynamic stabilization

Urgent surgical intervention is the definitive treatment for obstructive mechanical mitral valve thrombosis complicated by cardiogenic shock when thrombolysis is contraindicated.

Implication

Supports urgent surgery when thrombolysis contraindicated in obstructive mechanical mitral valve thrombosis with shock; leaves open generalizability pending prospective data.

Abstract

Prosthetic mechanical valve thrombosis (PMVT) is a rare but life-threatening complication associated with high morbidity and mortality. We report the case of a 35-year-old woman with a mechanical mitral prosthesis who presented with acute pulmonary edema and cardiogenic shock. Transesophageal echocardiography confirmed obstructive partial thrombosis. Thrombolysis was absolutely contraindicated because of a recent intracranial hemorrhage. After hemodynamic stabilization with inotropes, diuretics, non-invasive ventilation, and intravenous unfractionated heparin, urgent surgical intervention was considered the definitive therapeutic option. This case highlights the importance of early diagnosis, multidisciplinary heart team evaluation, and rapid surgical referral when fibrinolysis cannot be performed.

Discussion

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Cite This Study

Bennoui et al. (2026) conducted a case report in Obstructive mechanical mitral valve thrombosis complicated by cardiogenic shock (n=1). Urgent surgical intervention was evaluated. Urgent surgical intervention was recommended as the definitive therapeutic strategy for a patient with obstructive mechanical mitral valve thrombosis, cardiogenic shock, and an absolute contraindication to thrombolysis.

synapsesocial.com/papers/6ac72a2936c8cd5d094bf16a https://doi.org/10.69980/ajbr.v29i1s.9370

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Obstructive Mechanical Mitral Valve Thrombosis Complicated by Cardiogenic Shock With Absolute Contraindication to Thrombolysis: Surgical Management Strategy

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Obstructive Mechanical Mitral Valve Thrombosis Complicated by Cardiogenic Shock With Absolute Contraindication to Thrombolysis: Surgical Management Strategy

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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