Abstract
We report a case of acute thrombosis of bioprosthetic mitral valve in a 59 year–old Korean female, who underwent a mitral valve replacement with a 25 mm Carpentier - Edwards PERIMOUNT Plus bioprosthesis (Edwards Lifesciences, Inc.; Irvine, CA, USA) and a mini-Maze procedure for correction of mitral stenosis (MS) and atrial fibrillation (AF). On the 10th postoperative day, the patient began to complain of increasing dyspnea and general malaise. Her symptoms worsened and developed into pulmonary edema. Echocardiography revealed a mean diastolic pressure gradient (MDPG) of 10 mmHg across the mitral valve and pressure-half time (PHT) of 166 msec. Due to progressive decompensated heart failure, the patient underwent a repeat sternotomy to replace the bioprosthetic mitral valve. Intraoperatively, we found a thrombosis around the bioprosthetic mitral valve. We excised the bioprosthetic mitral valve and replaced it with a 27 mm ATS mechanical valve (ATS medical, Inc.; Minneapolis, MN, USA). We experienced a rare case that required an early reoperation for a thrombosis of the bioprosthetic valve.
Highlights
The advantage of using a bioprosthetic valve over a mechanical valve is that it lowers the incidence of thrombosis, avoiding the need for anticoagulant medication in the long term.The reported incidence of bioprosthetic valve thrombosis on routine echocardiography surveillance is approximately 6% [1]
She was diagnosed with moderate mitral stenosis (MS, valve area: 1.07 cm2 by 2D) and atrial fibrillation (AF)
A few cases involving the preservation of the mitral valve apparatus as a predisposing factor for bioprosthetic valve thrombosis have been reported because a complete preservation of the mitral valve apparatus during mitral
Summary
The advantage of using a bioprosthetic valve over a mechanical valve is that it lowers the incidence of thrombosis, avoiding the need for anticoagulant medication in the long term. Preoperative echocardiography showed a large left atrium (LA Volume Index: 81 ml / m2) She underwent preservation of the sub-valvular apparatus of posterior leaflet of the mitral valve and replacement with a 25 mm Carpentier – Edwards PERIMOUNT Plus bioprosthesis The bioprosthetic valve was removed and replaced with a 27 mm ATS mechanical valve (ATS Medical, Inc.; Minneapolis, MN, USA) She showed an improvement of symptoms, and repeat echocardiography showed a MDPG of 3.7 mmHg, PHT of 69 msec, a well functioning prosthetic valve, and no sign of thrombosis. She was discharged on Coumadin with an INR target of 2 to 2.5
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