A case of mitral valve plasty for Libman–Sacks endocarditis mimicking a cardiac tumor

Abstract

quency maze lesion lines were unlikely to be a source leading to propagation onto the valve leaflets because there were no intraatrial clots and thrombus was laminar along all the valve leaflets. Intravenous heparin was started in this patient with a plan to commence thrombolytic therapy if heparin alone was ineffective. Although thrombolytic therapy is an established first-line treatment, this patient responded to heparin anticoagulation followed by warfarin. Several studies have reported good resolution of bioprosthetic thrombus after conventional anticoagulation. Concurring with these studies, we had a favorable result after 1 week of heparin and subsequent warfarinization. Clinically significant bioprosthetic valve thrombosis is rare, although the reported incidence in the study by Oliver and colleagues is 6.2%. It should be considered a possible cause of valve dysfunction when there is increasing transvalvular pressure gradient after anticoagulation is terminated. Treatment with conventional anticoagulation is unavoidable in such a setting.