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Thrombolysis for COVID-19-associated bioprosthetic mitral valve thrombosis with shock.

ABSTRACT:

SUBMITTER: Vinnakota S

PROVIDER: S-EPMC8344413 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Highlights•Bioprosthetic valve thrombosis (BPVT) can occur beyond 3 months postimplantation.•BPVT can reoccur after successful treatment with fibrinolysis and anticoagulation.•Other forms of bioprosthetic valve dysfunction can coexist with thrombosis.•Echocardiography can promptly diagnose bioprosthesis thrombosis.•Management requires valve replacement, thrombolysis, or anticoagulation•After BPVT long-term anticoagulation may be required.

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Intracardiac Echocardiography to Diagnose Bioprosthetic Pulmonary Valve Thrombosis.

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Case report of successful low-dose, ultra-slow infusion thrombolysis of prosthetic mitral valve thrombosis in a high risk patient after redo-mitral valve replacement.

Project description:BackgroundAn increase in transvalvular pressure gradient of prosthetic valve should always raise suspicion for obstructive valve thrombosis. A multimodality diagnostic approach including transthoracic echocardiography, transoesophageal echocardiography (TOE), cinefluoroscopy, or computed tomography (CT) is necessary for a prompt diagnosis. The management of mechanical prosthetic valve thrombosis (PVT) is high risk in any therapeutic option taken. Emergency valve replacement is recommended for critically ill patients. Fibrinolysis is an alternative for patients with contraindication to surgery or if surgery is not immediately available.Case summaryA 52-year-old woman presented with symptoms and signs of cardiac congestion. On laboratory, brain natriuretic peptide was elevated and international normalized ratio (INR) was in subtherapeutic range. She underwent a mitral valve replacement with mechanical prosthesis 7 months before, because of a significant residual regurgitation after repair on the same year. TOE revealed severe stenosis of the prosthesis with immobile anterior disc but there was no mass present. CT revealed a minor lesion at the hinge points of the prosthesis without involvement of the ring, suggestive for thrombus. The initial fruitless management with intravenous (i.v) heparin in high therapeutic range was followed by a successful 'low-dose, ultra-slow' fibrinolysis.DiscussionCT may help differentiate thrombus vs. pannus. The acute onset of symptoms, inadequate anticoagulation, and restricted leaflet motion increased the suspicion for PVT. The current European guidelines propose normal dose fibrinolysis. We performed 'low-dose, ultra-slow' fibrinolysis due to lower bleeding risk with successful results. Low dose should be considered as alternative to normal dose fibrinolysis or urgent surgery.

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Case report: Mechanical mitral prosthetic valve thrombosis in the context of COVID-19 despite effective anticoagulation.

Project description:BackgroundThe SARS-CoV2 virus has been an emerging virus since December 2019 and is the cause of a global pandemic whose clinical manifestations extend far beyond respiratory disease.Case summaryA patient with severe coronavirus disease 2019 respiratory infection, carrying a mechanical mitral valve and under anticoagulation, was admitted to our cardiology department because of a new atrial fibrillation, which turned out to be related to thrombosis of the mitral mechanical valve.ConclusionThe pro-coagulant effect of the SARS-CoV2 virus does not spare patients at risk of thrombosis, even under effective anticoagulation. In patients with mechanical valves under vitamin K antagonist treatment, there is a high risk of thrombus formation. The treatment is based on thrombolysis by therapeutic anticoagulation, fibrinolysis, or surgery depending on the size, composition of thrombus, and clinical manifestation.

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A curious case of raised gradient across mitral bioprosthetic valve.

Project description:High Doppler valve gradient is generally suggestive of valve thrombosis. However, it should be corroborated with the finding of restricted leaflet movement to confirm the diagnosis. In the present case, abnormally high gradient was not associated with limited leaflet movements or any valve thrombus.

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