Abstract
A 70-year-old male underwent transfemoral transcatheter aortic valve implantation using a 26 mm SAPIEN XT valve (Edwards Lifesciences, Irvine, CA, USA). He received aspirin (100 mg/day) indefinitely and clopidogrel (75 mg/day) for one month. At sixmonth follow-up, the patient presented with recurrent symptoms of heart failure and angina. The echocardiogram depicted a severe transcatheter prosthesis stenosis, with a mean gradient of 48 mmHg. Multidetector computed tomography (MDCT) showed thickened leaflets along with low-density images, suggestive of thrombus (Figure1A, Figure1B, Moving image 1, Moving image 2). Twodimensional (2D) transoesophageal echocardiography (TEE) also revealed echogenic images suggestive of thrombus surrounding the leaflets, which were more evident by 3D TEE (Online Figure 1A,
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