Embolic ST-Segment Elevation Myocardial Infarction Following Aortic Prosthetic Valve Replacement: Diagnosis and Management Issues

Abstract

Acute thromboembolism resulting in ST-segment elevation myocardial infarction years after aortic valve replacement (AVR) is an uncommon occurrence. 38 years old female admitted with chest pain of 8 hours duration. Patient had history of Aortic valve replacement 3 years. Patient on evaluation found to have infero-lateral wall myocardial infarction. Coronary angiography (CAG) was done, which showed occlusive thrombus in the left coronary artery. The left circumflex artery after second obtuse marginal branch had total occlusion, and distal left anterior descending had total occlusion with thrombus containing lesion, whereas the right coronary artery was normal. The patient was thrombolyzed with intravenous streptokinase 1.5 mIU over 30 min infusion with door-to-needle time of 75 min. Pre- and postprocedure echocardiogram showed no evidence of thrombus. Gradient across the aortic valve and mobility was within the normal limits. Check CAG after 7 days showed resolution of thrombus burden in coronaries.