A young female with double mechanical prosthetic heart valves presenting with coronary embolism-a rare case report

Manju Sharma,Ratna Mani Gajurel,Smriti Shakya,Suman Adhikari,Chandra Mani Paudel,Surya Devkota,Sanjeev Thapa ,Vijay Yadav

doi:10.3126/jaim.v9i1.29167

Manju Sharma, Ratna Mani Gajurel + Show 6 more

Open Access

https://doi.org/10.3126/jaim.v9i1.29167

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Abstract

Coronary embolism, though uncommon, can occur in young patients with mechanical prosthetic heart valves. Coronary embolism has been reported in patients with prosthetic heart valves with or without thrombosis in literatures. It can cause acute coronary syndrome and lead to death if threshold of diagnosis of coronary embolism is not low. Here we report a case of coronary embolism in a 26 year old female with history of double mechanical prosthetic valve replacement, presenting to our centre with acute coronary syndrome. She was managed with thrombosuction establishing almost complete revascularization.

Highlights

Coronary embolism is a very uncommon cause of acute coronary syndrome and it can have multiple etiologies
As per literatures,coronary embolism can occur even with normally functioning prosthetic valves when associated with suboptimal anticoagulation.[4]
Coronary embolism is responsible for acute coronary syndrome in about 2.9 % of cases.[5]

Summary

Introduction

Coronary embolism is a very uncommon cause of acute coronary syndrome and it can have multiple etiologies. A 26 years old female,referred from some remote centre,without any known conventional risk factors for atherosclerotic coronary artery disease presented to us with chief complaints of typical anginal chest pain of 3 days duration She did not take tablet warfarin for last 3 weeks because of unavailability of the medicines in her place. The ECG done in emergency showed ST elevation in I,aVL,V3-V6 and the transthoracic echocardiography revealed hypokinesia of LAD territory with LVEF of 35% with normally functioning mechanical prosthetic valves (mean pressure gradients across mitral and aortic prosthetic valves were 2.7 mmHg and 13 mmHg respectively) with out any obvious thrombus (we could not perform transesophageal echocardiography though). The findings were suggestive of acute anterolateral STEMI As she was having ongoing chest pain, Cath lab was immediately activated and she underwent coronary angiography which surprisingly revealed complete thrombotic occlusion of proximal LAD artery.

Discussion

Conclusion